Appelhans Bradley M, Bleil Maria E, Crane Melissa M
Department of Family and Preventive Medicine, Rush University System for Health, Chicago, IL, USA.
Department of Child, Family, & Population Health Nursing, University of Washington, Seattle, WA, USA.
Appetite. 2025 Jun 3;214:108171. doi: 10.1016/j.appet.2025.108171.
Energy-dense discretionary foods and electronic entertainment are highly accessible and salient sources of reward in children's daily lives. This proof-of-concept study examined whether parent-facilitated recreational activities can displace these obesity-related behaviors in children ages 5-10 years (n = 60) from lower-income households. Parents were trained to implement the Traffic Light Eating Plan to encourage child intake of healthier vs. less healthy foods. No other changes were implemented in the baseline period of the protocol (Days 1-8). Families then participated in a structured session focused on identifying appealing and feasible recreational activities, and received funds to offset recreation costs. During protocol Days 10-17, parents were encouraged to facilitate recreational activities (e.g., arts and crafts, hobbies, games) as substitute rewards for eating and electronic entertainment. Parent reports of children's discretionary food intake, electronic entertainment use, and engagement in recreation were measured via ecological momentary assessment. In age- and sex-adjusted models, the odds of discretionary food consumption and electronic entertainment use were significantly lower during the recreation enhancement period compared to baseline. Time-varying analyses indicated that children used electronic entertainment less often when they were engaged in recreation. Children who were concurrently enrolled in organized non-sport activities outside of the study had lower odds of obesity-related behaviors. Children exhibited a relative preference for access to recreation over food and electronic entertainment in a behavioral economic choice task, and this preference varied by child weight status. Findings suggest that recreational activities might be leveraged to displace obesity-related behaviors in interventions to prevent and treat childhood obesity.
能量密集型的自由支配食品和电子娱乐是儿童日常生活中极易获取且十分突出的奖励来源。这项概念验证研究考察了在父母协助下的娱乐活动能否取代5至10岁（n = 60）低收入家庭儿童的这些与肥胖相关的行为。研究人员对家长进行培训，使其实施“红绿灯饮食计划”，以鼓励孩子摄入更健康而非不太健康的食物。在该方案的基线期（第1 - 8天）未实施其他改变。随后，家庭参与了一个结构化环节，重点是确定有吸引力且可行的娱乐活动，并获得资金以抵消娱乐成本。在方案的第10 - 17天，鼓励家长协助开展娱乐活动（如艺术和手工艺、爱好、游戏），作为饮食和电子娱乐的替代奖励。通过生态瞬时评估来测量家长报告的孩子自由支配食品摄入量、电子娱乐使用情况以及参与娱乐活动的情况。在年龄和性别调整模型中，与基线相比，在娱乐活动强化期自由支配食品消费和电子娱乐使用的几率显著降低。时变分析表明，孩子在参与娱乐活动时使用电子娱乐的频率较低。同时参加研究之外有组织的非体育活动的孩子出现与肥胖相关行为的几率较低。在一项行为经济选择任务中，孩子们表现出相对更倾向于获得娱乐活动而非食物和电子娱乐，并且这种偏好因孩子的体重状况而异。研究结果表明，在预防和治疗儿童肥胖的干预措施中，或许可以利用娱乐活动来取代与肥胖相关的行为。
