title: Association between barriers and facilitators to meeting the Dietary Guidelines for Americans and body weight status of caregiver-child dyads: the Healthy Eating and Lifestyle for Total Health Study.
abstract: BACKGROUND
  Few Americans meet the Dietary Guidelines for Americans (DGA), yet a large percentage are overweight.
  
  
  OBJECTIVE
  The goal of this research was to examine the association between barriers and facilitators to meeting the DGA and weight in a multisite study.
  
  
  METHODS
  This was a cross-sectional study in which 836 caregiver-child dyads among 3 race/ethnic groups completed the questionnaire across 6 sites participating in the HEALTH (Healthy Eating and Lifestyle for Total Health) Study. Barriers and facilitators to meeting the DGA were assessed by using a validated questionnaire developed specifically for the HEALTH Study. Heights and weights were measured. A series of bivariate regression analyses were conducted to examine the association between caregiver body mass index (BMI) or child BMI z score and the barriers and facilitators to meeting the DGA, adjusting for appropriate covariates in the models. Path analysis was used to examine the relation of caregiver and child barriers and facilitators to their relative BMIs.
  
  
  RESULTS
  In children, the BMI z score was associated positively (P < 0.001) with total barriers and negatively (P < 0.001) with total facilitators. In caregivers, BMI was associated positively only with total barriers (P < 0.0001). For each of the 8 MyPyramid components, barriers consistently were associated positively (P < 0.0001) and facilitators were associated negatively (P < 0.001) with BMI z score in children (with the exception of the fruit and physical activity components). For caregivers, most of the barriers to meeting recommendations for meats and beans; solid fats, alcohol, and added sugars; and physical activity components were associated positively (P < 0.01) with BMI. Path analyses show that caregiver facilitators were significantly related to children's facilitators to meeting DGA recommendations (standardized β: 0.12; P < 0.001).
  
  
  CONCLUSIONS
  To our knowledge, our findings are among the first to show associations between weight and barriers and/or facilitators to meeting the DGA in a national, large sample of caregiver-child dyads. This trial was registered at clinicaltrials.gov as NCT02725970.
authors.affiliation: USDA Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX; tnicklas@bcm.edu.
authors.forename: Theresa
authors.initials: T
authors.lastname: Nicklas
authors.affiliation: USDA Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX;
authors.forename: Yan
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Nutrition and Food Sciences, California State University Chico, Chico, CA;
authors.forename: Maria
authors.initials: M
authors.lastname: Giovanni
authors.affiliation: USDA Agricultural Research Service Grand Forks Human Nutrition Research Center, Grand Forks, ND;
authors.forename: Lisa
authors.initials: L
authors.lastname: Jahns
authors.affiliation: Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA;
authors.forename: Katherine
authors.initials: K
authors.lastname: Tucker
authors.affiliation: USDA Agricultural Research Service Western Human Nutrition Research Center, Obesity and Metabolism Research Unit, UC Davis, Davis, CA;
authors.forename: Kevin
authors.initials: K
authors.lastname: Laugero
authors.affiliation: USDA Agricultural Research Service Delta Obesity Prevention Research Unit, Dallas, TX;
authors.forename: Margaret
authors.initials: M
authors.lastname: Bogle
authors.affiliation: USDA Agricultural Research Service Beltsville Human Nutrition Research Center, Beltsville, MD.
authors.forename: Deirdra
authors.initials: D
authors.lastname: Chester
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001835:Body Weight; D017028:Caregivers; D002648:Child; D002652:Child Behavior; D003430:Cross-Sectional Studies; D004032:Diet; D004034:Diet Surveys; D005006:Ethnicity; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D018673:Nutrition Policy; D009765:Obesity / Q000517:prevention & control; D014481:United States
keywords: BMI; Dietary Guidelines for Americans; HEALTH; barriers; facilitators