Food availability and pediatric overweight: Fields of influence and bounded rationality

The prevalence of overweight among children of all age, ethnic and gender categories has increased dramatically since 1980. Many advances have been made in biomedical research relating to causes and consequences of obesity. However, these advances have not translated into useful models of causality, prevention or treatment, because they do not explore the interactions among socio-cultural and biological processes. The goal of this dissertation is to provide an integrative analysis of the food-related socio-cultural and biological forces and interactions that contributed to the increase in pediatric overweight between 1980 and 2005. These forces impact children's eating behaviors within school and home environments, and these venues are the focus of this study. The following data collection and analysis methods were employed: (1) random digit telephone survey of 297 parents of school-aged children analyzed using regression models; and (2) qualitative contextual analysis of in-depth interviews with 15 parents. Primary results reveal two factors that significantly contribute to establishment of home environments supportive of healthy eating (approval of restrictions on the availability of junk foods in schools and ethnicity, specifically being White), and six factors that significantly contribute to support for creating healthier school food environments (perceptions that pediatric obesity is a serious health problem, perception that obesity is largely due to poor eating habits, establishment of a healthy home food environment, respondent's spouse being less overweight, the interactive effect of respondent's work and marital status, and the interactive effect of respondent's work status and income). Interview data reveals that parents' time stressors and confusion regarding the nutritional quality of foods, as well as their support of food-related fundraising activities and food-based classroom parties leads to "accidental overfeeding" of children in both home and school environments. Overfeeding typically includes provision of foods of poor nutritional quality, which are increasingly available due to changes in food quality and price since the mid-1900s. Sociological constructs of bounded rationality and fields of influence, as well as organizational theory provide insight into the development of adults' actions and beliefs related to overfeeding.