Understanding Food Fussiness and Its Implications for Food Choice, Health, Weight and Interventions in Young Children: The Impact of Professor Jane Wardle
- 761 Downloads
Purpose of Review
This review examines the concepts of fussy eating and food neophobia in the context of key determinants of the development of children’s food preferences. We discuss the evidence for genetic versus parental and other environmental influences on the ontogeny of these behavioural traits and the implications of current knowledge for interventions that attempt to lessen the impact of these traits on children’s diets. Finally, we consider whether these traits increase the risk of a child becoming obese, or alternatively, underweight and malnourished.
Fussy eating and neophobia are related concepts with both genetic and environmental aetiologies. Parent-child correlations and heritability estimates are moderate to high for both traits, but aspects of the family environment remain influential in young children, although no longer in young adults. Parental strategies based around repeat tasting opportunities can improve acceptance of disliked foods in even the fussiest children. Fussy eating and neophobia are not risk factors for obesity but could limit growth in severe cases.
Fussy eating and food neophobia are common concerns for parents, though health risks are low. Dissemination of evidence-based strategies to parents that can encourage a more varied diet in young children would be helpful.
KeywordsChildren Picky/fussy eating Food neophobia Fruit Vegetables Body weight
Compliance with Ethical Standards
Conflict of Interest
E. Leigh Gibson and Lucy Cooke declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance; •• Of major importance
- 5.• Taylor CM, Wernimont SM, Northstone K, Emmett PM. Picky/fussy eating in children: Review of definitions, assessment, prevalence and dietary intakes. Appetite. 2015;95:349–59. doi: 10.1016/j.appet.2015.07.026. Useful recent review of picky/fussy, particularly for methodological and nutritional issues.PubMedCrossRefGoogle Scholar
- 15.•• Smith AD, Herle M, Fildes A, Cooke L, Steinsbekk S, Llewellyn CH. Food fussiness and food neophobia share a common etiology in early childhood. J Child Psychol Psychiatry. 2016. doi: 10.1111/jcpp.12647. Large twin cohort study providing clear evidence for both genes and shared environment in determining fussy eating and neophobia in young children.
- 16.•• Fildes A, van Jaarsveld CH, Cooke L, Wardle J, Llewellyn CH. Common genetic architecture underlying young children's food fussiness and liking for vegetables and fruit. Am J Clin Nutr. 2016;103(4):1099–104. doi: 10.3945/ajcn.115.122945. Large twin cohort study showing that common genes underlie much of the variance in both liking for fruits and vegetables and fussy eating in 3 year-olds.PubMedPubMedCentralCrossRefGoogle Scholar
- 17.• Smith AD, Fildes A, Cooke L, Herle M, Shakeshaft N, Plomin R, et al. Genetic and environmental influences on food preferences in adolescence. Am J Clin Nutr. 2016;104(2):446–53. doi: 10.3945/ajcn.116.133983. Large twin cohort study revealing genetic influence on preferences for different food groups in 18-19 year-olds, and that of non-shared but not shared environment.PubMedPubMedCentralCrossRefGoogle Scholar
- 20.Timpson NJ, Heron J, Day IN, Ring SM, Bartoshuk LM, Horwood J, et al. Refining associations between TAS2R38 diplotypes and the 6-n-propylthiouracil (PROP) taste test: findings from the Avon Longitudinal Study of Parents and Children. BMC Genet. 2007;8:51–9. doi: 10.1186/1471-2156-8-51.PubMedPubMedCentralCrossRefGoogle Scholar
- 21.• Pawellek I, Grote V, Rzehak P, Xhonneux A, Verduci E, Stolarczyk A, et al. Association of TAS2R38 variants with sweet food intake in children aged 1-6 years. Appetite. 2016;107:126–34. doi: 10.1016/j.appet.2016.07.034. Large longitudinal study of preschool children showing a specific association between the bitter taste related genotype TAS2R38 and consumption of sweet foods.PubMedCrossRefGoogle Scholar
- 23.Bell KI, Tepper BJ. Short-term vegetable intake by young children classified by 6-n-propylthoiuracil bitter-taste phenotype. Am J Clin Nutr. 2006;84(1):245-51. doi:84/1/245 [pii].Google Scholar
- 32.Gibson EL, Kreichauf S, Wildgruber A, Vogele C, Summerbell CD, Nixon C, et al. A narrative review of psychological and educational strategies applied to young children's eating behaviours aimed at reducing obesity risk. Obes Rev. 2012;13 Suppl 1:85–95. doi: 10.1111/j.1467-789X.2011.00939.x.PubMedCrossRefGoogle Scholar
- 35.Mennella JA, Beauchamp GK. Experience with a flavor in mother's milk modifies the infant's acceptance of flavored cereal. Dev Psychobiol. 1999;35(3):197–203. doi: 10.1002/(SICI)1098-2302(199911)35:3<197::AID-DEV4>3.0.CO;2-J.PubMedCrossRefGoogle Scholar
- 37.Sullivan SA, Birch LL. Infant dietary experience and acceptance of solid foods. Pediatr. 1994;93(2):271–7.Google Scholar
- 40.• Jones L, Moschonis G, Oliveira A, de Lauzon-Guillain B, Manios Y, Xepapadaki P, et al. The influence of early feeding practices on healthy diet variety score among pre-school children in four European birth cohorts. Public Health Nutr. 2015;18(10):1774–84. doi: 10.1017/s1368980014002390. Very large sample from four cohorts showing the important influence of breastfeeding on the healthiness of young children’s diets.PubMedCrossRefGoogle Scholar
- 50.Gregory JE, Paxton SJ, Brozovic AM. Pressure to eat and restriction are associated with child eating behaviours and maternal concern about child weight, but not child body mass index, in 2-to 4-year-old children. Appetite. 2010;54(3):550–6. doi: 10.1016/j.appet.2010.02.013.PubMedCrossRefGoogle Scholar
- 54.Tharner A, Jansen PW, Kiefte-de Jong JC, Moll HA, van der Ende J, Jaddoe VW, et al. Toward an operative diagnosis of fussy/picky eating: a latent profile approach in a population-based cohort. Int J Behav Nutr Phys Act. 2014;11:14. doi: 10.1186/1479-5868-11-14.PubMedPubMedCentralCrossRefGoogle Scholar
- 55.Birch LL. Effects of peer models food choices and eating behaviors on preschoolers food preferences. Child Dev. 1980;51(2):489–96.Google Scholar
- 65.• Xue Y, Lee E, Ning K, Zheng Y, Ma D, Gao H, et al. Prevalence of picky eating behaviour in Chinese school-age children and associations with anthropometric parameters and intelligence quotient. A cross-sectional study. Appetite. 2015;91:248–55. doi: 10.1016/j.appet.2015.04.065. Evidence for lower micronutrient levels in blood of 7-10 year-old picky eaters, as well as lower weight, but also of higher IQ.PubMedCrossRefGoogle Scholar
- 77.•• de Barse LM, Cardona Cano S, Jansen PW, Jaddoe VV, Verhulst FC, Franco OH, et al. Are parents' anxiety and depression related to child fussy eating? Arch Dis Child. 2016;101(6):533–8. doi: 10.1136/archdischild-2015-309101. Important recent evidence that parental anxiety and depression tendencies were prospectively associated with fussy eating in their children.PubMedCrossRefGoogle Scholar
- 84.Cooke LJ, Haworth CM, Wardle J. Genetic and environmental influences on children's food neophobia. Am J Clin Nutr. 2007;86(2):428-33. doi:86/2/428 [pii].Google Scholar
- 86.Knaapila A, Silventoinen K, Broms U, Rose RJ, Perola M, Kaprio J, et al. Food neophobia in young adults: genetic architecture and relation to personality, pleasantness and use frequency of foods, and body mass index--a twin study. Behav Genet. 2011;41(4):512–21. doi: 10.1007/s10519-010-9403-8.PubMedCrossRefGoogle Scholar
- 98.• Fildes A, van Jaarsveld CH, Wardle J, Cooke L. Parent-administered exposure to increase children's vegetable acceptance: a randomized controlled trial. J Acad Nutr Diet. 2014;114(6):881–8. doi: 10.1016/j.jand.2013.07.040. Useful at-home intervention system for parents to apply ‘exposure plus reward’ that successfully increased vegetable consumption.PubMedPubMedCentralCrossRefGoogle Scholar
- 99.• Skouteris H, Hill B, McCabe M, Swinburn B, Busija L. A parent-based intervention to promote healthy eating and active behaviours in pre-school children: evaluation of the MEND 2-4 randomized controlled trial. Pediatr Obes. 2016;11(1):4–10. doi: 10.1111/ijpo.12011. Intensive 10-week intervention to reduce obesity risk in young children resulted in reduced food neophobia at 12 months follow-up, though not at 6 months post-intervention. Thus, parents may have continued the taste exposure intervention, suggesting that 10 weeks was too short to affect neophobia.PubMedCrossRefGoogle Scholar
- 100.Ensaff H, Crawford R, Russell JM, Barker ME. Preparing and sharing food: a quantitative analysis of a primary school-based food intervention. J Public Health (Oxf). 2016. doi: 10.1093/pubmed/fdw086.
- 101.• Battjes-Fries MC, Haveman-Nies A, Zeinstra GG, van Dongen EJ, Meester HJ, van den Top-Pullen R et al. Effectiveness of Taste Lessons with and without additional experiential learning activities on children's willingness to taste vegetables. Appetite. 2016. doi: 10.1016/j.appet.2016.05.020. Large-scale intervention in 10-year-olds from 33 primary schools: lack of intervention effects suggests more intense interventions needed and/or at an earlier age.
- 102.• Laureati M, Bergamaschi V, Pagliarini E. School-based intervention with children. Peer-modeling, reward and repeated exposure reduce food neophobia and increase liking of fruits and vegetables. Appetite. 2014;83:26–32. doi: 10.1016/j.appet.2014.07.031. Replication of ‘Food Dudes’ modelling intervention, with reduced neophobia as an outcome.PubMedCrossRefGoogle Scholar
- 106.• Antoniou EE, Roefs A, Kremers SP, Jansen A, Gubbels JS, Sleddens EF, et al. Picky eating and child weight status development: a longitudinal study. J Hum Nutr Diet. 2016;29(3):298–307. doi: 10.1111/jhn.12322. Dutch picky eaters followed from age 5 to 9 tended to be shorter and were more likely to be underweight than non-picky eaters.PubMedCrossRefGoogle Scholar
- 108.• de Barse LM, Tiemeier H, Leermakers ET, Voortman T, Jaddoe VW, Edelson LR, et al. Longitudinal association between preschool fussy eating and body composition at 6 years of age: The Generation R Study. Int J Behav Nutr Phys Act. 2015;12:153. doi: 10.1186/s12966-015-0313-2. Longitudinal study (2 years) reporting lower fat-free mass in fussy eaters vs. non-fussy eaters at 6 years old.PubMedPubMedCentralCrossRefGoogle Scholar
- 109.• Mallan KM, Fildes A, Magarey AM, Daniels LA. 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. J Acad Nutr Diet. 2016;116(4):630–7. doi: 10.1016/j.jand.2015.06.006. No evidence for differences in BMI by fussy eating status in children under 4 years old.PubMedCrossRefGoogle Scholar
- 112.• Berger PK, Hohman EE, Marini ME, Savage JS, Birch LL. Girls' picky eating in childhood is associated with normal weight status from ages 5 to 15 y. Am J Clin Nutr. 2016. doi: 10.3945/ajcn.116.142430. The longest longitudinal study following effects of picky eating on weight change after 10 years in girls only: picky eaters had lower but healthy weight.