title: Mealtime behavior among siblings and body mass index of 4-8 year olds: a videotaped observational study.
abstract: BACKGROUND
  Being a last-born child and having a sister have been associated with higher body mass index (BMI). Encouragement to eat that overrides children's self-regulation has been reported to increase the risk of obesogenic eating behaviors. This study sought to test the hypothesis that encouragement to eat during mealtime from older siblings and sisters mediates associations of being last-born or having a sister with higher BMI.
  
  
  METHODS
  Children aged 4-8 years (n = 75) were videotaped while eating a routine evening meal at home with one sibling present. Encouragement to eat (defined as direct prompts to eat or general positive statements about food) delivered to the index child (IC) from the sibling was coded from the videotape. Path analysis was used to examine associations between IC's birth order, sibling's sex, encouragement counts, and IC's measured BMI z-score (BMIz).
  
  
  RESULTS
  Being the younger sibling in the sibling dyad was associated with the IC receiving more encouragements to eat from the sibling (β: 0.93, 95 % confidence interval (CI): 0.59, 1.26, p < 0.0001). The IC having a sister compared with a brother was not associated with the IC receiving more encouragements to eat from the sibling (β: 0.18, 95 % CI: -0.09, 0.47, p = 0.20). The IC receiving more encouragements to eat from the sibling was associated with lower IC BMIz (β: -0.06, 95 % CI: -0.12, 0.00, p = 0.05).
  
  
  CONCLUSIONS
  Children were more likely to receive encouragements to eat from older siblings than younger siblings. Being the recipient of encouragements to eat from a sibling was associated with lower, not higher, child BMIz, which may reflect sibling modeling of maternal behavior. Future longitudinal studies are needed to examine whether encouragements to eat from siblings lead to increase in BMI over time. Encouragements from siblings may be a novel intervention target for obesity prevention.
authors.affiliation: Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA. rmosli@umich.edu.|Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jedddah, Kingdom of Saudi Arabia. rmosli@umich.edu.
authors.forename: Rana H
authors.initials: RH
authors.lastname: Mosli
authors.affiliation: Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA. alimill@umich.edu.|Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA. alimill@umich.edu.
authors.forename: Alison L
authors.initials: AL
authors.lastname: Miller
authors.affiliation: Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA. nicola@umich.edu.
authors.forename: Niko
authors.initials: N
authors.lastname: Kaciroti
authors.affiliation: Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA. karenep@umich.edu.|Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA. karenep@umich.edu.|Department of Nutrition, Harvard School of Public Health, Boston, MA, USA. karenep@umich.edu.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Peterson
authors.affiliation: Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA. katier@umich.edu.|Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA. katier@umich.edu.
authors.forename: Katherine
authors.initials: K
authors.lastname: Rosenblum
authors.affiliation: Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA. abaylin@umich.eduv.
authors.forename: Ana
authors.initials: A
authors.lastname: Baylin
authors.affiliation: Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA. jlumeng@umich.edu.|Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA. jlumeng@umich.edu.|Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA. jlumeng@umich.edu.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Lumeng
mesh_terms: D001722:Birth Order; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D004435:Eating; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D062407:Meals; D063766:Pediatric Obesity / Q000209:etiology*; D012737:Sex Factors; D035781:Siblings; D012931:Social Environment