Children's Eating Behaviors and Energy Intake: Overlapping Influences and Opportunities for Intervention

The transition from risk factors in the first 1,000 days to childhood obesity occurs largely through the development of maladaptive eating behaviors that emerge early, remain stable, and support greater energy intake over time. We have examined the association between eating behaviors, energy intake, and body composition at 4.5 and 6 years of age among children from the GUSTO (Growing Up in Singapore towards Healthy Outcomes) cohort. Our findings demonstrate that when children select larger portions, eat at a faster rate, and continue to eat when sated, they consume more energy than children who do not exhibit these behaviors. We have shown that these behaviors are stable over time and independently predict higher adiposity and BMI z scores at the later time point. We observed that faster eating and greater intakes were associated with parent report measures of appetitive traits, such as the child's satiety responsiveness, food fussiness, and enjoyment of food. Importantly, faster eating rates mediated the link between these appetitive traits and child energy intakes. In addition, within-meal parental feeding practices were linked to a faster eating rate, higher energy intakes, and higher BMI z scores in some children, suggesting that parents are aware of these eating behaviors and likely adapt their feeding practices to influence their child's energy intake. These findings emphasize the need to consider the interaction and cumulative impact of these eating behaviors and parental feeding practices on children's energy intake, and, consequently, the need to develop holistic intervention approaches that target the behaviors that contribute most to a child's risk of developing overweight and obesity.