Using the positive deviance approach, the purpose of this study was to identify parent feeding practices that might be protective against early childhood obesity among children with lower weight status (BMI percentile ≥5th-<85th) relative to higher weight status (BMI percentile ≥85th). Qualitative interviews were conducted with 71 parents of children aged 2–5 years old (48% girls) enrolled in the Minnesota Special Supplemental Nutrition Program for Women Infants and Children (WIC). Children were identified as having lower weight status (defined as ‘positive deviants’) (n = 36) or ‘higher weight status’ (n = 35), and were African American [n = 22], Hispanic [n = 23], or Hmong [n = 26]). Parents were asked about approaches to child feeding and health- and weight-related practices. Findings indicated that relative to caregivers of children with higher weight status, parents of children identified as positive deviant were more likely to report having a consistent routine for providing meals, using a guided choices approach, serving small portions of food during mealtimes, and trusting their child hunger and satiety cues. Moreover, parents of children identified as positive deviant were more likely to promote healthful eating and physical activity engagement and implement clear rules and limits for screen time than parents of children with higher weight status. Results suggest specific parent feeding behaviors and health-related practices that may influence child weight status among children living in low-income and racialized households. The findings of this study also provide research evidence and support the tenets of the Satter Division of Responsibility in Feeding framework. Parenting practices and strategies among parents of children identified as positive deviant are expected to be feasible and should be explored and communicated in future interventions to support age- and sex-recommended weight and health-related outcomes among young children to promote health equity.
Bibliographical noteFunding Information:
This research was supported by grant number 6 T79MC000073001 (PI: J Stang) from the Health Resources and Services Administration ( HRSA ) Maternal and Child Health Bureau ( MCHB ). The first author's (JN de Brito) predoctoral training was supported by the National Heart, Lung, and Blood Institute ( NHLBI ) T32 Research on Eating and Activity for Community Health (REACH) Applied Epidemiology Training Program (T32HL150452; PI: D Neumark-Sztainer) and the postdoctoral training was supported by the National Institute of Diabetes and Digestive and Kidney Diseases ( NIDDK ) T32 Minnesota Obesity Prevention Training (MnOPT) (T32DK083250; PIs: RW Jeffery, CM Kotz). Funders had no role in the design, analysis, or writing of this article.
© 2022 Elsevier Ltd
- Health equity
- Parenting practices
- Pediatric obesity
- Positive deviance
- Qualitative research