Introduction
Several aspects of the proposed intervention can be addressed from the point of view of relevant academic literature. Particularly, it is important to recognize that parental supervision and guidance can have different forms, and literature should be analyzed for the advantages and disadvantages of these forms. Also, to ensure the appropriateness of the research design, key concepts should be examined by turning to available research findings; these concepts include diet choice and improvement in the context of healthy eating. In reviewing academic literature, the notion of dietary practices was examined, the advantages and challenges of parent involvement in the provision of diet choice interventions were explored, and the relevance of the literature to the proposed project was established.
Dietary Practices
Dietary practices are a crucial consideration in the proposed study. Initial, pre-intervention dietary practices of the adolescent targets will be measured as a baseline, and post-intervention dietary practices will be examined for the assessment of intervention outcomes. However, it should be specified what is meant by dietary practices and how they are related to improvements for adolescents with BMI-related challenges.
Dietary practices can be defined as everyday activities associated with the amount and type of consumed food, food preferences, eating schedule, and considerations that affect the decision-making process concerning what to eat, how to eat it when to eat it (including how often), and how much of it to eat. Scholars have recognized that dietary practices are an important consideration in healthy diet choice interventions; however, no single framework for assessing dietary practices has been detected in academic literature; most studies adopted specific frameworks based on their individual research design.
For example, Antoniou et al. (2015) pay particular attention to how picky children are in choosing their food. A number of correlations were found between higher or lower pickiness and weight status. Particularly, it was found that “[p]icky eaters with a normal weight at baseline…were less likely to become overweight compared to non-picky eaters” (Antoniou et al., 2015, p. 298). However, in this regard, parental advice was found ineffective; children did not demonstrate any readiness to be less particular about their eating practices due to parenting practices. Neither was a correlation established between such practices and weight status.
On the other hand, some authors have confirmed that certain other dietary practices can be affected by parents. For example, Ho et al. (2012) reported that dietary restrictions imposed on children and adolescents by parents can be an effective element of interventions; however, it is not clear if the practice of restricting food consumption can be considered parental supervision, which is the method in the proposed study, and it is evident that food consumption restrictions are beyond parental advice. This shows that there are different degrees of modifying dietary practices.
Advantages of Parent Involvement
There is no consensus among scholars concerning the effectiveness of parent involvement in diet choices interventions, and this is repeatedly stressed in relevant studies. For example, Schlechter, Rosenkranz, Guagliano, and Dzewaltowski (2016) claimed that “[w]hether parent involvement increases intervention effectiveness remains unclear” (p. 237); however, the authors explored how various relevant studies reported reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) of interventions that had addressed children’s dietary practices and choices, and it was found that effectiveness was the highest reported element.
Similarly, Ho et al. (2012) confirmed that parent involvement had been considered effective in many studies and had been regarded as particularly important in research that aimed at reducing adolescents’ BMI. Concerning the degree of involvement (see Practices), the best results in terms of BMI reduction were received in studies that employed training programs for adolescents and parents combined with dietary restriction depending on reported energy intake. Ho et al. (2012) stress that “almost all effective interventions…reported including a family component, including separate education sessions for parent and child” (p. e1667); however, it is not always explained why parent involvement is important and presumably effective.
The answer was proposed by Jewell, Blessitt, Stewart, Simic, and Eisler (2016); as they studied the role of family support in addressing eating disorders among children and adolescents, they argued that the family environment is “supportive and non-blaming” (p. 577), and this is important for addressing the issue of anxiety, which is often present in adolescents with BMI-related challenges. The authors also claimed that family support accelerates the effects of interventions because the family environment is naturally closer to a patient than the clinical setting and more capable of promoting behavior change, such as diet choices. Finally, family support provides additional motivation for intervention targets and a more positive attitude toward expected outcomes.
Challenges of Parent Involvement
As it was previously shown, it is unclear how effective parent involvement is in diet choice interventions for children and adolescents (see Advantages of Parent Involvement); along with advantages, there are considerable challenges.
For example, in their evaluation of the agent-of-change role of parents in behavior change interventions for obese children, Faith et al. (2012) found that, in 17 percent of intervention studies only, parent involvement was indicated as a factor in the improvement of outcomes during the treatments of overweight children. Also, different studies referred to different parenting strategies in their attempts to evaluate the effectiveness of parent involvement in interventions. Therefore, it can be said that, although the effectiveness of parent involvement is often recognized, it is unclear what particular type of involvement is effective.
Similarly, Davison, Jurkowski, Li, Kranz, and Lawson (2013) found that parent involvement often fails to demonstrate effectiveness in terms of changing diet choices of children. However, unlike Faith et al. (2012), the authors put more emphasis on the degree of involvement than on the form of involvement. It is claimed that the lack of effectiveness is often due to the fact that parents are not properly reached or are not properly explained how they are supposed to participate in interventions, what strategies they should adopt, and what the expected benefits of the interventions are.
While Jewell et al. (2016) discussed the family context as a beneficial and productive environment for diet change interventions, Davison et al. (2013) noted that to achieve such a context, parents should be willing and able to be engaged, but there are barriers to implementing this. What is recommended is encouraging parents to participate not only in interventions but also in the intervention development process. This will allow creating a family-centered approach to diet choice interventions and shifting from viewing parents as agents of change to viewing them as the intervention providers. This perspective can be considered for the proposed project in order to focus on tailoring the intervention according to the parents’ needs and vision.
Relevance
Parental involvement is considered a key aspect of the proposed intervention because what will be measured is the effectiveness of parental supervision and guidance in diet choice-related behavior change. The reviewed literature suggests that there is no single vision of how effective such involvement is or a single understanding of what strategies parents should adopt to ensure successful behavior change. The reviewed literature also addressed the issue of population assessment, and it was stressed that the population should be specific and measurable (Antoniou et al., 2015; Schlechter et al., 2016), which will be taken into consideration in the proposed project.
Other key aspects of the proposed project addressed in the reviewed literature are the degree of intervention, the form of intervention, and the vision of the role of parents; all three are interconnected. If parents are viewed as the agents of change, as suggested by Faith et al. (2012) and Schlechter et al. (2016), it is not planned to engage them in the intervention design process; however, if the chosen approach is family-centered, as suggested by Davison et al. (2013), more extensive participation will be expected from parents.
The literature review has shown that the concept of parental supervision used in the research question of the proposed project needs to be further specified in terms of the proportion of advice to action; for example, parents may restrict food consumption of their adolescent children (Ho et al., 2012), or the supervision can be limited to advise and monitoring of compliance with certain dietary practices.
Conclusion
The literature review has shown that, although parents cannot fully change their children’s eating behaviors, some dietary practices can be modified. Parent involvement in diet choice interventions can be effective if parents are properly reached, engaged, and explained the expected benefits. The literature suggests that more attention should be paid to defining the form and degree of parent involvement when designing interventions that employ parental supervision and guidance for improving adolescents’ BMI and dietary practices.
References
Antoniou, E. E., Roefs, A., Kremers, S. P., Jansen, A., Gubbels, J. S., Sleddens, E.F., & Thijs, C. (2015). Picky eating and child weight status development: A longitudinal study. Journal of Human Nutrition and Dietetics, 29(3), 298-307.
Davison, K. K., Jurkowski, J. M., Li, K., Kranz, S., & Lawson, H. A. (2013). A childhood obesity intervention developed by families for families: Results from a pilot study. International Journal of Behavioral Nutrition and Physical Activity, 10(1), 1-11.
Faith, M. S., Van Horn, L., Appel, L. J., Burke, L. E., Carson, J. A. S., Franch, H. A., … Wylie-Rosett, J. (2012). Evaluating parents and adult caregivers as “agents of change” for treating obese children: Evidence for parent behavior change strategies and research gaps. Circulation, 125(9), 1186-1207.
Ho, M., Garnett, S. P., Baur, L., Burrows, T., Stewart, L., Neve, M., & Collins, C. (2012). Effectiveness of lifestyle interventions in child obesity: Systematic review with meta-analysis. Pediatrics, 130(6), e1647-e1671.
Jewell, T., Blessitt, E., Stewart, C., Simic, M., & Eisler, I. (2016). Family therapy for child and adolescent eating disorders: A critical review. Family Process, 55(3), 577-594.
Schlechter, C. R., Rosenkranz, R. R., Guagliano, J. M., & Dzewaltowski, D. A. (2016). A systematic review of children’s dietary interventions with parents as change agents: Application of the RE-AIM framework. Preventive Medicine, 91(1), 233-243.