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Obesity has become a significant yet preventable public health problem of the twenty first century. Over 10% of American children ages 2-5 years old are overweight (Body mass index (BMI) ? 95%). Studies have demonstrated that many children’s diets are high in fat and calories and low in nutrient rich fruits and vegetables. Many children’s dietary intake includes an increasing consumption of fast food. Adult chronic diseases such as type II diabetes and hypertension or their risk factors are now seen in childhood. This trend makes early prevention through lifestyle modification of healthy diet a potentially important public health and primary care prevention strategy. Some researchers have studied overweight in preschool children, parental diet related attitudes and knowledge, fruit and vegetable, and fast food intake of young children. No study was located investigating either fast food dollars spent in families and obesity/overweight or all variables together in children ages 2-5 years.

The purpose of this study was to examine preschool children’s parents’ dietary attitudes and knowledge, and determine the possible correlation of family fast food dollars and/or fruit and vegetable intake with children’s body mass index for age (BMI). These findings may assist nurses and other health care providers in directing strategies to promote healthy life long diets.

Obesity has become the second leading cause of preventable deaths in the United States. Overweight (greater or equal to 95% of the gender specific BMI) in children has increased over the last few decades. The National Health and Nutrition Examination Survey (NHANES) 1999-2000 reported the prevalence of overweight children ages 2-5 years old was 10.4%, a 3.2% increase from 1988-1994. Studies found that older preschool children (4-5 years) have a higher overweight prevalence than younger preschool children.9,11 A recent study found that overweight prevalence in children ages 2-19 years had increased by 182% between 1971 and 1999-2000.10 The extent overweight or the average amount that children’s BMI goes beyond their age and gender specific overweight threshold increased to 247% over the past 30 years. These findings suggest that overweight children are becoming heavier. This significant rise in overweight in children has become a major public health concern because it is a risk factor for a myriad of chronic diseases, as well as being a financial burden. Multiple studies link overweight in childhood to subsequent obesity morbidity and mortality in adulthood. However, the sequelae of obesity are not limited to adulthood as evidenced by the increasing concomitant conditions in overweight youth.

Parents are the primary role models of preschool children. Exploring parents’ dietary beliefs and behaviors may be important in determining whether these factors influence young children’s weight. Parental diet related attitudes, knowledge and behaviors, and family fast food dollars spent have been explored.

Several studies have examined diet related attitudes, knowledge, and obesity. However, these studies all tend to take a slightly different perspective, and have not specifically focused on parental diet related attitudes and knowledge, family fast food dollars spent, and preschool children’s fruit and vegetable consumption. In a study by Kuchler and Lin, women who did not believe their weight was predetermined had lower BMI compared to those who believed their weight was predetermined. Higher parental nutrition knowledge was associated with a lower prevalence of overweight in children. While most parents (?70%) know the correct United States Department of Agriculture (USDA) recommended fruit servings per day,only 34% of parents know the correct vegetable daily servings. Income level was a determining variable in parental awareness of correct recommended vegetables ervings. Only 34% of adults were aware of the correct daily vegetable servings, and low income adults were significantly less likely to know the correct servings of vegetables compared to high income adults. Guthrie and Fulton24 found the quantity of fruit consumed was negatively associated with increased body mass index. Colavitio and colleagues12 examined the relationship of meal planners’ diet health related attitudes and knowledge to the food intake of children ages 2 to 5 years. Their findings suggested that parents’ taste preferences rather than nutritional knowledge may have more of an influence on their fast food choice.

A study investigating the relationship between obesity and the consumption of fruit and vegetables noted that adults and children who consumed diets high in fruits and vegetables were thinner. Lin and Morrison15 concluded that those with lower BMI’s consumed diets high in fruit, but found no consistent correlation between vegetable intake and BMI in a study that included children ages 5-17 years. In another study, Field and colleagues concluded while girls, ages 9-14 years, fruit and vegetable intake was lower than recommendations in a cross-sectional cohort, no significant correlation in BMI z-score change and fruit and vegetable intake was noted. Their findings suggested that in boys ages 9-14, vegetable intake was inversely related to changes in BMI z-score (per serving = -0.003). Mother’s education level and child’s age and gender were suggested by Cooke and colleagues as predictors of children’s vegetable intake, while ethnicity was a predictor of fruit consumption. Their findings further suggested that parental fruit and vegetable intake, the early introduction of fruit and vegetables into a child’s diet, and breastfeeding are predictors of both fruit and vegetable intake. Brady and colleagues studied the dietary intake of children and the recommended USDA Pyramid Dietary Guidelines; they found only 5% of children met the fruit consumption guidelines and 20% met the recommended vegetable servings, suggesting that children may not consume the recommended servings per day of fruit and vegetables. Kranz and colleagues’ found an increase in American preschoolers’ fruit and vegetable intake over the last 30 years. However, their findings suggest that younger preschool children eat higher amounts of fruits and vegetables, with children of age years exceeding two servings of fruit, but not, on average, meeting the recommended three servings of vegetables.

Fast foods. Over the last few decades, fast food consumption has increased in the United States. Interestingly, two studies indicated that there was not a consistent association between fast food intake and obesity. The trend in fast food as a staple in American children’s diet in the 1970’s has increased from 12% of total calories to 25% in the 1990’s. Americans’ fast food consumption rose from 3% in 1977-78 to 9% in 1995. Over the last 20 years, there has been a 14% increase in away from home food consumption, which includes fast food. Adults’ (ages 18 to 39 years) average calorie intake for away from home food increased 16% over the time period and was the highest of all age groups. This is significant because most parents of preschool children are in this age group. While preschool children consumed the least quantity of fast food of any age group, their consumption increased from 12% to 24% of their total caloric intake between 1977-78 and 1994-96. Fast food has been suggested as a determinant of increased BMI by some researchers,30 while other research has not found a link between the two. French and colleagues31 studied fast food consumption among Mid western urban children, examining demographic and behavioral factors. Fast food consumption was directly associated with greater total energy intake and greater percentage of energy from fat than those not consuming fast food during a one week time period. Fast food consumption was associated with a lower daily intake of fruit and vegetables and may adversely effect the quality of dietary intake. A recent study found fast food consumption greater among males, higher income households, and those living in the Southern region.

The literature clearly demonstrates that overweight in children is a growing crisis with potential life-long consequences. The increases in adult obesity associated mortality and morbidity, as well as the morbidity seen in overweight children and adolescents, have generated a growing public health concern. Limited work has focused on younger children, parental attitudes and knowledge, fruit and vegetable consumption, and fast food intake; no published studies have examined this combination of factors in children 2 to 5 years of age. This study may assist in a better understanding of parental diet related attitudes and knowledge, and of family fast food dollars and their correlation to children’s BMI and overweight status. This information may lead to development of nursing and public health strategies aimed at the reduction of overweight incidence and prevalence, especially among children.

Parental diet related attitude and knowledge provided the conceptual foundation for this study as depicted in Figure 1 based on a review of literature. Studies supported the conceptual links of parental diet related attitudes and knowledge with the variables of family fast food dollars, children’s BMI-age gender specific and children’s fruit and vegetable intake. Assumptions for this study were parents as the primary influence and role models for children ages 2-5 years and parents’ diet-related attitude and knowledge provide the most significant influence for young children’s fast food and fruit and vegetable consumption.

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