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The Role of the Home Environment in Early Weight Trajectories

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The Role of the Home Environment in Early Weight Trajectories THE ROLE OF THE HOME ENVIRONMENT IN EARLY WEIGHT TRAJECTORIES Stephanie Georgina Schrempft A thesis submitted for the degree of Doctor of Philosophy UCL Declaration I, Stephanie Schrempft, confirm that the work presented in this thesis is my own. Where information has been derived from other sources, I confirm that this has been indicated. Acknowledgements I would like to thank: Professor Jane Wardle for the wonderful opportunity to study at the Health Behaviour Research Centre (HBRC); it has been a challenging and rewarding experience, which has put me in good stead for the future; My supervisors Dr Ellen van Jaarsveld and Dr Abigail Fisher for their invaluable support throughout my time at the HBRC; Dr Clare Llewellyn for her statistical support and general advice; Laura McDonald and Amy Ronaldson for assisting with the home environment telephone interviews; Dr Aiden Doherty, Dr Charlie Foster, and Dr Paul Kelly for their advice on using SenseCam; and the SenseCam steering committee for loaning the SenseCams; All of the families who took part in my research; My fellow PhD students for their friendship and good humour; And my family for always being there. This thesis is dedicated in fond memory of Professor John Wattam-Bell (1953 – 2013). Abstract Dramatic increases in the prevalence of overweight and obesity have prompted a focus on prevention. Weight is known to have a strong genetic basis, but the speed of change in rates of overweight and obesity against a relatively stable gene pool suggests that exposure to an ‘obesogenic’ environment is important. The home environment is thought to play a key role in early weight trajectories, providing an avenue for long-term obesity prevention. There is evidence for associations between various aspects of the home environment and energy-balance behaviours; however, evidence for associations with weight is limited, particularly in early childhood. Few studies have used comprehensive, psychometrically-tested measures of the home environment, and no studies have tested for gene- environment interaction in the home context. This thesis uses data from the Gemini twin cohort to further examine the role of the home environment. Study one describes the development of a comprehensive measure of the home environment in early childhood, including the quantification of the extent that the home is likely to be obesogenic. Study two explores the utility of a novel tool called SenseCam to examine and validate aspects of the home environment measure. Study three identifies a number of maternal characteristics associated with the obesogenic quality of the home environment. Study four shows associations between the obesogenic quality of the home environment and energy-balance behaviours; while study five finds no association with weight. Findings from study six highlight the role of gene-environment interaction, showing that the heritability of weight is higher among children living in home environments with greater obesogenic potential. Overall, the findings of this thesis further understanding on how the home environment contributes to the development of overweight and obesity. Implications, limitations, and avenues for future research are discussed. Table of Contents Declaration .............................................................................................................. 2 Acknowledgements .................................................................................................. 3 Abstract ................................................................................................................... 4 Table of Contents .................................................................................................... 5 List of Tables ......................................................................................................... 12 List of Figures ........................................................................................................ 15 List of Appendices ................................................................................................. 16 Chapter 1 . Defining and measuring the obesogenic home environment ............... 17 1.1 The Obesity Epidemic .................................................................................. 17 1.1.1 Prevalence and cost .............................................................................. 17 1.1.2 Health consequences ............................................................................ 17 1.2 Causes ......................................................................................................... 18 1.2.1 Positive energy balance ......................................................................... 18 1.3 The role of the home environment in early childhood ................................... 24 1.3.1 Defining the obesogenic home environment .......................................... 25 1.3.2 Measuring the obesogenic home environment ....................................... 28 1.3.3 Physical aspects of the home environment: availability and accessibility 29 1.3.4 Social aspects of the home environment: parental modelling and support, feeding practices, and household policies ....................................................... 31 1.3.5 Multi-component measures: incorporating physical and social aspects .. 32 1.4 Summary ...................................................................................................... 34 Chapter 2 : Associations between the obesogenic home environment, energy- balance behaviours, and weight ............................................................................. 43 2.1 Characteristics associated with the obesogenic quality of the home environment ....................................................................................................... 43 2.1.1 Demographic characteristics .................................................................. 43 2.1.2 Parental attitudes and traits ................................................................... 46 2.1.3 Early parenting practices........................................................................ 47 2.2 Associations between the home food environment, food and beverage consumption, and weight .................................................................................... 48 2.2.1 Physical aspects .................................................................................... 48 2.2.2 Social aspects ........................................................................................ 52 2.3 Associations between the home activity environment, physical activity, and weight ................................................................................................................ 57 2.3.1 Physical aspects .................................................................................... 57 2.3.2 Accessibility of physical activity facilities ................................................ 58 2.3.3 Social aspects of the home activity environment .................................... 59 2.4 Associations between the home media environment, television viewing, and weight ................................................................................................................ 61 2.4.1 Physical aspects .................................................................................... 61 2.4.2 Social aspects of the home media environment ..................................... 64 2.5 Conceptual issues ........................................................................................ 67 2.5.1 Examining the combined influence of multiple home environment variables ......................................................................................................... 67 2.5.2 Role of Gene-Environment interaction ................................................... 69 2.6 Summary and aims of the present thesis ...................................................... 71 Chapter 3 . Sampling and methodology ................................................................. 73 3.1 Overview of Gemini ...................................................................................... 73 3.2 Sample and recruitment ............................................................................... 73 3.3 Data collection .............................................................................................. 76 3.3.1 Twin zygosity ......................................................................................... 77 3.3.2 Anthropometrics ..................................................................................... 78 3.3.3 Age ........................................................................................................ 78 3.3.4 Socioeconomic status ............................................................................ 79 3.3.5 Household composition .......................................................................... 79 3.3.6 Ethnicity ................................................................................................. 79 3.3.7 Breastfeeding and solid food introduction .............................................. 80 3.3.8 Parental feeding practices ...................................................................... 80 3.3.9 Parental eating traits .............................................................................. 82 3.3.10 Parental happiness .............................................................................. 83 Chapter 4 . Development of the Home Environment Interview
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