Date of Award


Degree Type


Degree Name

Doctor of Philosophy in Health Sciences


Nutrition and Food Sciences

First Advisor

Alison Tovar


Overweight and obesity effect one in three children in the US, with significant disparities for Non-Hispanic Black and Hispanic/ Latinx children. Factors such as rapid weight gain, non-responsive feeding practices, and poor diet quality in infancy and early childhood can contribute to the development of obesity. An in depth understanding of what predicts these factors is necessary to inform and improve obesity prevention and treatment efforts. This is especially important to understand in the communities disproportionately impacted by childhood obesity. Therefore, the objective of this dissertation was to explore the contextual factors that influence rapid weight gain, non-responsive feeding practices, and diet quality in infants and young children at increased risk for developing obesity. We developed a conceptual model using self-determination theory and hypothesized that caregivers’ psychological well-being influences the socio-emotional context of feeding and can impact the child’s obesity risk.

The first study was a longitudinal secondary data analysis of Nurture, a completed birth cohort of predominately Black mothers and their infants (n=666) that explored the impact of maternal perceived stress on change in weight-for-length (WFL) z-scores and risk of rapid weight gain in infancy. Mixed model analysis of repeated measures assessed associations between perceived stress and change in WFL z-score from 3 months to 6, 9, and 12 months. Log-binomial models assessed the association between perceived stress and rapid weight gain from 3 months to 12 months. We found that rapid infant weight gain was prevalent in the sample, with nearly half of infants experiencing rapid weight gain between 3 and 12 months postpartum. Contrary to our hypothesis we did not find evidence that mothers perceived stress influenced weight gain trajectories or risk of rapid weight gain in the first year of life.

The second and third studies were cross-sectional secondary data analyses of baseline data collected as part of the Strong Families Start at Home Study; a pilot randomized control trial with predominately Hispanic/Latinx caregivers of preschool-aged children (n=67). The second study used multivariable linear regressions to assess the association between caregivers’ basic psychological need satisfaction and frustration with responsive (autonomy supportive and structured) and non-responsive (controlling and chaotic) feeding. We found that psychological need frustration was positively associated with controlling and chaotic feeding. Contrary to our hypothesis, need satisfaction was not significantly associated with autonomy supportive or structured feeding.

The third study explored how children’s eating behaviors influence their eating patterns and diet quality. We evaluated associations between eating behaviors and total diet quality score using multivariable linear regression. We assessed the impact of eating behaviors on the odds of high intake of components of diet quality including milk, whole grains, refined grains, protein, fruits, vegetables, fruit juice, sugar-sweetened beverages, other added sugars, and salty snacks using logistic regression. We found that meal size was negatively associated with food fussiness and satiety responsiveness, while positively associated with food responsiveness. The size of caloric beverages outside meals and snacks was positively associated with food fussiness. Exploratory analyses showed that eating behaviors were significantly associated with refined grain, fruit, and sugar-sweetened beverage scores.

Together, these studies provide evidence that interventions aiming to improve caregivers’ feeding should support caregiver’s psychological needs while considering differences in children’s eating behaviors that may influence what nutritional targets need to be prioritized. This information can be used as targets for intervention to promote the development of healthy eating for children. We also highlight areas where research is needed, particularly with regards to rapid weight gain in infancy, and the role of maternal stress, and eating behaviors in diet quality and childhood obesity risk.



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