Comparison of Early Feeding Practices in Mother-Father Dyads and Possible Generalization of an Efficacious Maternal Intervention to Fathers' Feeding Practices: A Secondary Analysis.

To compare feeding practices within mother-father dyads and explore whether outcomes of an efficacious intervention for mothers generalised to fathers' feeding practices. The NOURISH RCT evaluated an early feeding intervention that promoted positive feeding practices to support development of healthy eating habits and growth. The intervention was delivered to first-time mothers via 2 × 12 week modules commencing when children were 4 and 14 months. Mothers self-reported feeding practice outcomes at child age 2 years using validated scales (1 = low to 5 = high) from the Child Feeding Questionnaire (CFQ). Nine months later, an independent cross-sectional descriptive study to investigate fathers' feeding practices was initiated. Fathers were recruited by contacting (via letter) mothers participating in two pre-existing studies, including the NOURISH trial. Fathers completed a feeding practices questionnaire, similar to that used for NOURISH outcome assessments. Seventy-five fathers recruited via the NOURISH cohort (21% response) returned questionnaires. Response data from this subset of fathers were then linked to the corresponding NOURISH maternal data. Complete data were available from 70 dyads. Compared with mothers, fathers self-reported higher concern about child overweight (2.2 vs. 1.3), restriction (3.6 vs. 2.9) and pressure (2.6 vs. 2.1), all p < 0.001. Fathers whose partners were allocated to the intervention group used less pressure (mean difference 0.46, p = 0.045) and were more willing to let the child decide how much to eat (-0.51, p = 0.032). Fathers' higher concern about child weight and more frequent use of non-responsive feeding practices, when compared with mothers, identify them as potentially potent contributors to child feeding. This preliminary evidence for modest generalisation of an efficacious maternal intervention to apparent effects on some paternal feeding practices speaks to the importance and promise of including fathers in early feeding interventions.

Weight status and diets of children aged 1-12 years attending a tertiary public paediatric outpatient clinic.

AIM: To assess the weight status and diets of a sample of paediatric outpatients, explore the relationship between the two and compare child weight status with parental perception of child weight and parents' self-reported weight. METHODS: Parents/carers of 1-12-year-olds attending paediatric outpatients at Flinders Medical Centre, South Australia, between October 2015 and May 2016 completed a demographic and validated age-based dietary questionnaire (toddlers (1-3 years), pre-schoolers (>3 to <5 years) or children (5-12 years)). Dietary risk scores (low/moderate/high/very high) were calculated for toddlers and pre-schoolers and diet quality and food behaviours scores for children. Body mass index (BMI) z-score and weight status were determined from measured height and weight. RESULTS: Of 114 toddlers, 115 pre-schoolers and 250 children, 65% were of a healthy weight, 10% underweight and 25% overweight or obese. Most (~80%) toddlers and pre-schoolers had diets classified as 'moderate' risk, and the diets (35-90%) and behaviours (90%) of most 5-12-year-olds fell short of the guidelines. There was no significant relationship between overall diet risk or quality and BMI z-score. Healthier food behaviours scores were inversely correlated with BMI z-scores (ß -0.061, 95% confidence interval (CI) -0.089, -0.033, P < 0.005). Parents' perception of child weight status was inaccurate. Parent's self-reported weight status was significantly associated with the BMI z-scores of toddlers (ß 0.301, 95% CI 0.189-1.174, P = 0.007) and pre-schoolers (ß 0.220, 95% CI 0.032-0.859, P = 0.035). CONCLUSIONS: Poor diets and high rates of overweight/obesity highlight the need for screening within the paediatric outpatient setting. Parents' own weight status, and their inaccurate perception of their child's, should be considered future intervention targets for improving child and parent health.

Feasibility of a Group-Based, Facilitator-Directed Online Family Lifestyle Program.

OBJECTIVE: This study aimed to overcome barriers to access and attendance, and improve recruitment and engagement, through delivery and evaluation of the Parenting, Eating and Activity for Child Health (PEACH) child weight management program, as a facilitated group-based online healthy lifestyle program, PEACH Lifestyle. METHODS: Pre-post feasibility study of an online intervention comprising a website with 10 self-directed learning modules and 6 facilitated group-based video conferencing sessions with parents (n = 79) of children (7.9 ± 2.9 years, 25% healthy weight, 23% obese). RESULTS: Three enrollees were from remote locations. Half of the parents (n = 38) attended ≥1 video conferencing session (median = 3 participants per session [Range, 0-7]). Thirty percent (n = 7 of 21) completed all 10 online modules. Technical issues, time, and family commitments were barriers to engagement. CONCLUSIONS AND IMPLICATIONS: Reframing and delivering a weight management program as a healthy lifestyle program online in real-time did not address barriers to engagement in PEACH Lifestyle.

Poor dietary patterns at 1-5 years of age are related to food neophobia and breastfeeding duration but not age of introduction to solids in a relatively advantaged sample.

Previous studies have investigated associations between individual foods or food group intake, and breastfeeding duration, age of solid introduction and food neophobia. This study aimed to investigate associations between whole dietary patterns in young children, and breastfeeding duration, age of solid introduction and food neophobia. Parents of children (N = 234) aged 1-5 years completed an online questionnaire. Dietary risk scores were calculated using the Toddler (1-3 years) or Preschool (>3-<5 years) Dietary Questionnaires which evaluates the previous week's food-group intake (scored 0-100; higher score = higher risk of poor dietary quality). Neophobia was measured using the Child Food Neophobia scale (1.0-4.0; higher score = more neophobic). Associations were investigated using multivariable linear regression, adjusting for covariates. Children (54% female, 3.0 ±â€¯1.4 years) were from advantaged families and were breastfed until 11.8 (5.0-16.0) months, started solids at 5.6 ±â€¯1.4 months of age, moderately neophobic (2.1 ±â€¯0.7) and at moderate dietary risk (29.2 ±â€¯9.2). Shorter breastfeeding duration (ß = -0.21; p = 0.001) and poorer child food neophobia scores (ß = 0.36; p < 0.001) were associated with higher dietary risk scores. Age of introduction to solids showed no association with dietary risk (p = 0.744). These findings suggest that in addition to breastfeeding promotion, supporting parents to manage neophobic behaviour may be important in promoting healthy eating patterns in early childhood.

Pre-post evaluation of a weight management service for families with overweight and obese children, translated from the efficacious lifestyle intervention Parenting, Eating and Activity for Child Health (PEACH).

Parenting, Eating and Activity for Child Health (PEACH) is a multi-component lifestyle intervention for families with overweight and obese children. PEACH was translated from an efficacious randomised-controlled trial (RCT) and delivered at scale as PEACH Queensland (QLD) in Queensland, Australia. The aim of this study is to explore pre-post changes in parenting, and child-level eating, activity and anthropometry, in the PEACH QLD service delivery project. PEACH QLD enrolled 926 overweight/obese children (817 families). Pre-programme evaluation was completed for 752 children and paired pre-post-programme evaluation data were available for 388 children. At baseline, children with pre-post-programme data were (mean) 8·8 years old, and at follow-up were 9·3 years old, with mean time between pre-post-programme measures of 0·46 years. Outcomes reflected each domain of the PEACH programme: parenting, eating behaviour of the child and activity behaviours (means reported). Parents reported improvements in parenting self-efficacy (3·6 to 3·7, P=0·001). Children had improved eating behaviours: eating more daily serves of vegetables (2·0 to 2·6, P=0·001) and fewer non-milk sweetened beverages (0·9 to 0·6, P=0·001) and discretionary foods (2·2 to 1·5, P=0·001). Children spent more time in moderate-to-vigorous physical activity (86 to 105 min/d, P=0·001) and less time in sedentary screen-based behaviours (190 to 148 min/d, P=0·001). Consequently, there were significant improvements in mean BMIz (-0·112; P<0·001) and weight status (healthy weight/overweight/obese/morbidly obese prevalence from 0/22/33/45 % to 2/27/34/37 %, P<0·001). When delivered at scale, PEACH remains an effective family-based, multi-component, lifestyle weight management programme for overweight and obese children whose families engage in the programme.

Practicalities and Research Considerations for Conducting Childhood Obesity Prevention Interventions with Families.

Internationally, childhood obesity is a major public health concern. Given the established difficulties in treating obesity, designing and evaluating effective obesity prevention interventions are research priorities. As parents play a crucial role in establishing positive health behaviours in children, they are a key target for child obesity prevention programs. However, recruiting and engaging parents in such interventions can be a considerable challenge for researchers and practitioners. Members of the 'Parenting, Child Behaviour and Well-being' stream of the Australasian Child and Adolescent Obesity Research Network (ACAORN) have considerable and varied expertise in conducting such interventions and can provide insights into addressing these challenges. This paper aims to highlight considerations regarding the design, implementation, and evaluation of obesity prevention interventions with families and provide practical insights and recommendations for researchers and practitioners conducting family-based research in this area. Case studies of three family-based interventions conducted by ACAORN members are highlighted to provide examples and contextualise the recommendations proposed.

The Relationship between Number of Fruits, Vegetables, and Noncore Foods Tried at Age 14 Months and Food Preferences, Dietary Intake Patterns, Fussy Eating Behavior, and Weight Status at Age 3.7 Years.

OBJECTIVE: We examined whether exposure to a greater number of fruits, vegetables, and noncore foods (ie, nutrient poor and high in saturated fats, added sugars, or added salt) at age 14 months was related to children's preference for and intake of these foods as well as maternal-reported food fussiness and measured child weight status at age 3.7 years. METHODS: This study reports secondary analyses of longitudinal data from mothers and children (n=340) participating in the NOURISH randomized controlled trial. Exposure was quantified as the number of food items (n=55) tried by a child from specified lists at age 14 months. At age 3.7 years, food preferences, intake patterns, and fussiness (also at age 14 months) were assessed using maternal-completed, established questionnaires. Child weight and length/height were measured by study staff at both age points. Multivariable linear regression models were tested to predict food preferences, intake patterns, fussy eating, and body mass index z score at age 3.7 years adjusting for a range of maternal and child covariates. RESULTS: Having tried a greater number of vegetables, fruits, and noncore foods at age 14 months predicted corresponding preferences and higher intakes at age 3.7 years but did not predict child body mass index z score. Adjusting for fussiness at age 14 months, having tried more vegetables at age 14 months was associated with lower fussiness at age 3.7 years. CONCLUSIONS: These prospective analyses support the hypothesis that early taste and texture experiences influence subsequent food preferences and acceptance. These findings indicate introduction to a variety of fruits and vegetables and limited noncore food exposure from an early age are important strategies to improve later diet quality.

Food neophobia and its association with diet quality and weight in children aged 24 months: a cross sectional study.

BACKGROUND: Food neophobia, the rejection of unknown or novel foods, may result in poor dietary patterns. This study investigates the cross-sectional relationship between neophobia in children aged 24 months and variety of fruit and vegetable consumption, intake of discretionary foods and weight. METHODS: Secondary analysis of data from 330 parents of children enrolled in the NOURISH RCT (control group only) and SAIDI studies was performed using data collected at child age 24 months. Neophobia was measured at 24 months using the Child Food Neophobia Scale (CFNS). The cross-sectional associations between total CFNS score and fruit and vegetable variety, discretionary food intake and BMI (Body Mass Index) Z-score were examined via multiple regression models; adjusting for significant covariates. RESULTS: At 24 months, more neophobic children were found to have lower variety of fruits (ß = -0.16, p = 0.003) and vegetables (ß = -0.29, p < 0.001) but have a greater proportion of daily energy from discretionary foods (ß = 0.11, p = 0.04). There was no significant association between BMI Z-score and CFNS score. CONCLUSIONS: Neophobia is associated with poorer dietary quality. Results highlight the need for interventions to (1) begin early to expose children to a wide variety of nutritious foods before neophobia peaks and (2) enable health professionals to educate parents on strategies to overcome neophobia.

Attitudes and characteristics of health professionals working in Aboriginal health.

INTRODUCTION: There is an unacceptable gap in health status between Aboriginal and non-Aboriginal people in Australia. Linked to social inequalities in health and political and historical marginalisation, this health gap must be urgently addressed. It is important that health professionals, the majority of whom in Australia are non-Aboriginal, are confident and equipped to work in Aboriginal health in order to contribute towards closing the health gap. The purpose of this study was to explore the attitudes and characteristics of non-Aboriginal health professionals working in Aboriginal health. METHODS: The research was guided and informed by a social constructionist epistemology and a critical theoretical approach. It was set within a larger healthy eating and physical activity program delivered in one rural and one metropolitan community in South Australia from 2005 to 2010. Non-Aboriginal staff working in the health services where the program was delivered and who had some experience or an interest working in Aboriginal health were invited to participate in a semi-structured interview. Dietitians working across South Australia (rural and metropolitan locations) were also invited to participate in an interview. Data were coded into themes that recurred throughout the interview and this process was guided by critical social research. RESULTS: Thirty-five non-Aboriginal health professionals participated in a semi-structured interview about their experiences working in Aboriginal health. The general attitudes and characteristics of non-Aboriginal health professionals were classified using four main groupings, ranging from a lack of practical knowledge ('don't know how'), a fear of practice ('too scared'), the area of Aboriginal health perceived as too difficult ('too hard') and learning to practice regardless ('barrier breaker'). Workers in each group had different characteristics including various levels of willingness to work in the area; various understandings of Australia's historical relationship with Aboriginal peoples; varying awareness of their own cultural identity and influence on working with Aboriginal people; and different levels of (dis)comfort expressed in discussions about social, political and intercultural issues that impact on the healthcare encounter. CONCLUSIONS: These groupings can be used to assist non-Aboriginal health professionals to reflect on their own levels of confidence, attitudes, characteristics, experiences, approaches and assumptions to Aboriginal health, as an important precursor to further practice and development in Aboriginal health. By encouraging self-reflection of non-Aboriginal health professionals about where their experiences, characteristics and confidence lie, the groupings presented in this paper can be used to encourage non-Aboriginal health professionals, rather than Aboriginal clients or workers, to be the focus for change and deliver health care that is more acceptable to patients and clients, hence influencing health service delivery. The groupings presented can also begin to enable discussions between all health professionals about working together in Aboriginal health.

A longitudinal investigation of overweight children's body perception and satisfaction during a weight management program.

BACKGROUND: The Children's Body Image Scale (CBIS) is a measure of body perception and satisfaction. Obesity has a negative impact on children's body satisfaction. This study aimed to (1) determine the construct validity of the CBIS in a purely overweight/obese sample, and (2) explore longitudinal changes in body perception and satisfaction in overweight/obese children participating in a six month weight management program delivered to parents. Data were self-reported by overweight/obese 5 to 9 year old children (n = 127) over a 36 month period. FINDINGS: The CBIS demonstrated good construct validity (Rho: range 0.38 to 0.71, p < 0.05). Accuracy in body size perception did not alter significantly over time (Rho: range 0.45 to 0.59, p < 0.001). No consistent differences in body satisfaction by age or sex were observed. Body satisfaction improved after the six month weight management intervention (mean difference = 0.74, 95% CI 0.15-1.26) which was maintained at 36 month follow up. CONCLUSION: The CBIS is a useful measure to monitor overweight/obese children's body satisfaction. In this cohort, it is suggestive that the child weight management program delivered to parents did not impact negatively on children's body satisfaction.

The influence of maternal infant feeding practices and beliefs on the expression of food neophobia in toddlers.

Food neophobia is a highly heritable trait characterized by the rejection of foods that are novel or unknown and potentially limits dietary variety, with lower intake and preference particularly for fruits and vegetables. Understanding non-genetic (environmental) factors that may influence the expression of food neophobia is essential to improving children's consumption of fruits and vegetables and encouraging the adoption of healthier diets. The aim of this study was to examine whether maternal infant feeding beliefs (at 4 months) were associated with the expression of food neophobia in toddlers and whether controlling feeding practices mediated this relationship. Participants were 244 first-time mothers (M=30.4, SD=5.1 years) allocated to the control group of the NOURISH randomized controlled trial. The relationships between infant feeding beliefs (Infant Feeding Questionnaire) at 4 months and controlling child feeding practices (Child Feeding Questionnaire) and food neophobia (Child Food Neophobia Scale) at 24 months were tested using correlational and multiple linear regression models (adjusted for significant covariates). Higher maternal Concern about infant under-eating and becoming underweight at 4 months was associated with higher child food neophobia at 2 years. Similarly, lower Awareness of infant hunger and satiety cues was associated with higher child food neophobia. Both associations were significantly mediated by mothers' use of Pressure to eat. Intervening early to promote positive feeding practices to mothers may help reduce the use of controlling practices as children develop. Further research that can further elucidate the bi-directional nature of the mother-child feeding relationship is still required.

Maternal feeding self-efficacy and fruit and vegetable intakes in infants. Results from the SAIDI study.

Adequate consumption of fruits and vegetables (FV) is a characteristic of a healthy diet but remains a challenge in nutrition interventions. This cross-sectional study explored the multi-directional relationships between maternal feeding self-efficacy, parenting confidence, child feeding behaviour, exposure to new food and FV intake in a cohort of 277 infants. Mothers with healthy infants weighing ≥2500 g and ≥37 weeks gestation were recruited post-natally from 11 South Australian hospitals. Socio-demographic data were collected at recruitment. At 6 months postnatal, infants were weighed and measured, and mothers completed a questionnaire exploring their perceptions of child feeding behaviour and child exposure to new foods. The questionnaire also included the Short Temperament Scale for Infants, Kessler 10 to measure maternal psychological distress and 5 items measuring maternal feeding self-efficacy. The number of occasions and variety of FV (number of subgroups within food groups) consumed by infants were estimated from a 24-hour dietary recall and 2 days food record. Structural equation modelling was performed using Mplus version 6.11. Median (IQR) variety scores were 2 (1-3) for fruit and 3 (2-5) for vegetable intake. The most popular FV consumed were apple (n = 108, 45.0%) and pumpkin (n = 143, 56.3%). None of the variables studied predicted the variety of child fruit intake. Parenting confidence, exposure to new foods and child feeding behaviour were indirectly related to child vegetable intake through maternal feeding self-efficacy while total number of children negatively predicted child vegetable variety (p < 0.05). This highlights the need for addressing antecedents of maternal feeding self-efficacy and the family eating environment as key strategies towards development of healthy eating in children.

A short food-group-based dietary questionnaire is reliable and valid for assessing toddlers' dietary risk in relatively advantaged samples.

Identifying toddlers at dietary risk is crucial for determining who requires intervention to improve dietary patterns and reduce health consequences. The objectives of the present study were to develop a simple tool that assesses toddlers' dietary risk and investigate its reliability and validity. The nineteen-item Toddler Dietary Questionnaire (TDQ) is informed by dietary patterns observed in Australian children aged 14 (n 552) and 24 (n 493) months and the Australian dietary guidelines. It assesses the intake of 'core' food groups (e.g. fruit, vegetables and dairy products) and 'non-core' food groups (e.g. high-fat, high-sugar and/or high-salt foods and sweetened beverages) over the previous 7 d, which is then scored against a dietary risk criterion (0-100; higher score = higher risk). Parents of toddlers aged 12-36 months (Socio-Economic Index for Areas decile range 5-9) were asked to complete the TDQ for their child (n 111) on two occasions, 3·2 (SD 1·8) weeks apart, to assess test-retest reliability. They were also asked to complete a validated FFQ from which the risk score was calculated and compared with the TDQ-derived risk score (relative validity). Mean scores were highly correlated and not significantly different for reliability (intra-class correlation = 0·90, TDQ1 30·2 (SD 8·6) v. TDQ2 30·9 (SD 8·9); P= 0·14) and validity (r 0·83, average TDQ ((TDQ1+TDQ2)/2) 30·5 (SD 8·4) v. FFQ 31·4 (SD 8·1); P= 0·05). All the participants were classified into the same (reliability 75 %; validity 79 %) or adjacent (reliability 25 %; validity 21 %) risk category (low (0-24), moderate (25-49), high (50-74) and very high (75-100)). Overall, the TDQ is a valid and reliable screening tool for identifying at-risk toddlers in relatively advantaged samples.

Satiety responsiveness in toddlerhood predicts energy intake and weight status at four years of age.

The aim of this study was to examine whether maternal-report of child eating behaviour at two years predicted self-regulation of energy intake and weight status at four years. Using an 'eating in the absence of hunger' paradigm, children's energy intake (kJ) from a semi-standardized lunch meal and a standardized selection of snacks were measured. Participants were 37 mother-child dyads (16 boys, Median child age=4.4years, Inter-quartile range=3.7-4.5years) recruited from an existing longitudinal study (NOURISH randomised controlled trial). All participants were tested in their own home. Details of maternal characteristics, child eating behaviours (at age two years) reported by mothers on a validated questionnaire, and measured child height and weight (at age 3.5-4years) were sourced from existing NOURISH trial data. Correlation and partial correlation analyses were used to examine longitudinal relationships. Satiety responsiveness and Slowness in eating were inversely associated with energy intake of the lunch meal (partial r=-.40, p=.023, and partial r=-.40, p=.023) and the former was also negatively associated with BMI-for-age Z score (partial r=-.42, p=.015). Food responsiveness and Enjoyment of food were not related to energy intake or BMI Z score. None of the eating behaviours were significantly associated with energy intake of the snacks (i.e., eating in the absence of hunger). The small and predominantly 'healthy weight' sample of children may have limited the ability to detect some hypothesized effects. Nevertheless, the study provides evidence for the predictive validity of two eating behaviours and future research with a larger and more diverse sample should be able to better evaluate the predictive validity of other children's early eating behaviour styles.

Short tools to assess young children's dietary intake: a systematic review focusing on application to dietary index research.

Dietary indices evaluate diet quality, usually based on current dietary guidelines. Indices can therefore contribute to our understanding of early-life obesity-risk dietary behaviours. Yet indices are commonly applied to dietary data collected by onerous methods (e.g., recalls or records). Short dietary assessment instruments are an attractive alternative to collect data from which to derive an index score. A systematic review of studies published before April 2013 was conducted to identify short (≤50 items) tools that measure whole-of-diet intake of young children (birth-five years) and are applicable to dietary indices, in particular screening obesogenic dietary behaviours. The search identified 3686 papers of which 16, reporting on 15 tools (n = 7, infants and toddlers birth-24 months; n = 8, preschoolers 2-5 years), met the inclusion criteria. Most tools were food frequency questionnaires (n = 14), with one innovative dietary questionnaire identified. Seven were tested for validity or reliability, and one was tested for both. Six tools (n = 2, infants and toddlers; n = 4, preschoolers) are applicable for use with current dietary indices, five of which screen obesogenic dietary behaviours. Given the limited number of brief, valid and reliable dietary assessment tools for young children to which an index can be applied, future short tool development is warranted, particularly for screening obesogenic dietary behaviours.

Predictors of and reasons for pacifier use in first-time mothers: an observational study.

BACKGROUND: The use of pacifiers is commonplace in Australia and has been shown to be negatively associated with breastfeeding duration. In order to influence behaviour related to the use of pacifiers it is important to understand the reasons for their use. The primary aim of this observational study was to investigate who (if anyone) advises first-time mothers to give a pacifier and the reasons for which they first give (or try to give) a pacifier to their infant. Additionally, this study investigated the predictors of pacifier use and the relationship between pacifier use and breastfeeding duration. METHODS: In total, 670 Australian first-time mothers recruited as part of the NOURISH trial completed a questionnaire regarding infant feeding and pacifier use. RESULTS: Pacifiers were introduced by 79% of mothers, of whom 28.7% were advised to use a pacifier by their mother/mother-in-law with a further 22.7% being advised by a midwife. The majority of mothers used a pacifier in order to soothe their infant (78.3%), to help put them to sleep (57.4%) and to keep them comforted and quiet (40.4%). Pacifiers given to infants before four weeks (adjHR 3.67; 95%CI 2.14-6.28) and used most days (adjHR 3.28; 95%CI 1.92-5.61) were significantly associated with shorter duration of breastfeeding. CONCLUSIONS: This study identifies an opportunity for educating new mothers and their support network, particularly their infant's grandmothers, with regards to potential risks associated with the early and frequent use of a pacifier, and alternative methods for soothing their infant, in order to reduce the use of pacifiers and their potentially negative effect on breastfeeding duration.

Children's food and activity patterns following a six-month child weight management program.

OBJECTIVE: To describe the impact of a parent-led, family-focused child weight management program on the food intake and activity patterns of pre-pubertal children. METHODS: An assessor-blinded, randomized controlled trial involving 111 (64% female) overweight, pre-pubertal children 6-9 years of age randomly assigned to parenting-skills training plus intensive diet and activity education (P + DA), parenting-skills training alone (P), or a 12-month wait-listed control (WLC). Study outcomes were assessed at baseline, 6 months, and 12 months. This paper presents data on food intake assessed via a validated 54-item parent-completed dietary questionnaire and activity behaviours assessed via a parent-report 20-item activity questionnaire. RESULTS: Intake of energy-dense nutrient-poor foods was lower in both intervention groups at 6 months (mean difference, P + DA - 1.5 serves [CI - 2.0; -1.0]; P - 1.0 serves [-2.0; -0.5]) and 12 months (mean difference P + DA - 1.0 serves [CI - 2.0; -0.5]; P - 1.0 serves [- 1.5; 0.0]) compared to baseline. Intake of vegetables, fruit, breads and cereals, meat and alternatives and dairy foods remained unchanged. Regardless of study group there were significant reductions over time in the reported time spent engaged in small screen activities and an increase in the time reported spent in active play. CONCLUSION: A child weight management intervention that promotes food intake in line with national dietary guidelines achieves a reduction in children's intake of energy-dense, nutrient-poor foods. This was achieved without compromising intake of nutrient-rich food and changes were maintained even once the intervention ceased.