What is the question?

• The question is: What is the relationship between parental and caregiver feeding styles and practices during childhood and growth, body composition and risk of obesity? The population of interest for this question includes children ages 2 to 6 years.

Why was this question asked?

• This systematic review was conducted by the 2025 Dietary Guidelines Advisory Committee as part of the process to develop the Dietary Guidelines for Americans, 2025-2030.

How was this question answered?

• The Committee conducted a new systematic review to answer this question with support 
  from the USDA Nutrition Evidence Systematic Review team.

What is the answer to the question?

• Food parenting practices involving monitoring of children's eating by caregivers of children ages 2 to 6 years is not associated with outcomes related to growth. This conclusion statement is based on evidence graded as limited.
• A conclusion statement cannot be drawn about the relationship between food parenting practices by caregivers of children ages 2 to 6 years that structure children’s physical and social eating environments (e.g., availability of healthy foods, modeling of healthy eating behaviors, meal routines such as eating together as a family) and outcomes related to growth, body composition, and risk of obesity because there was not enough evidence available.
• A conclusion statement cannot be drawn about the relationship between controlling feeding practices by caregivers of children ages 2 to 6 years and outcomes related to growth, body composition, and risk of obesity because there are substantial concerns with consistency in the body of evidence.
• A conclusion statement cannot be drawn about the relationship between food parenting practices by caregivers of children ages 2 to 6 years that provide developmentally appropriate support for children's autonomy (e.g., responsive feeding, praise, child involvement in food and eating activities) and outcomes related to growth, body composition, and risk of obesity because there are few studies and substantial concerns with consistency in the body of evidence.
• A conclusion statement cannot be drawn about the relationship between feeding styles by caregivers of children ages 2 to 6 years and outcomes related to growth, body composition, and risk of obesity because there are substantial concerns with consistency in the body of evidence.

How up-to-date is this systematic review?

• Conclusion statements from this review are based on articles published between January 2000 and July 2023.

Background

• This systematic review was conducted by the 2025 Dietary Guidelines Advisory Committee as part of the process to develop the Dietary Guidelines for Americans, 2025-2030. The U.S. Departments of Health and Human Services (HHS) and Agriculture (USDA) appointed the 2025 Dietary Guidelines Advisory Committee (Committee) in January 2023 to review evidence on high priority scientific questions related to diet and health. Their review forms the basis of their independent, science-based advice and recommendations to HHS and USDA, which is considered as the Departments develop the next edition of the Dietary Guidelines. As part of that process, the Committee conducted a systematic review with support from USDA’s Nutrition Evidence Systematic Review (NESR) team to answer the following question: What is the relationship between parental and caregiver feeding styles and practices during childhood and growth, body composition and risk of obesity?

Methods

• The Committee conducted a systematic review using the methodology of the USDA NESR team. The Committee first developed a protocol. The intervention/exposure and comparators were parental or caregiver feeding styles or practices in children 2 to 6 years, and the outcomes were measures of growth, body composition, and risk of obesity in children and adolescents 2 to 19 years. Additional inclusion criteria were established for the following study characteristics: a) use randomized or non-randomized controlled trial, prospective or retrospective cohort, or nested case-control/other study designs, b) be published in English in peer-reviewed journals, c) be studies from countries classified as high or very high on the Human Development Index, and d) enroll participants with a range of health statuses. The review excluded multicomponent interventions in which the isolated effects of the caregiver feeding styles and practices on growth, body composition or risk of obesity could not be determined.
• NESR librarians conducted a literature search in PubMed, Embase, CINAHL, and Cochrane to identify articles published between January 2000 and July 2023. Two NESR analysts independently screened all electronic results and the reference lists of included articles based on the pre-determined criteria. NESR analysts extracted data, from each included article, with a second analyst verifying accuracy of the extraction. Two NESR analysts independently conducted a formal risk of bias assessment, by study design, for each included article, then reconciled any differences in the assessment. The Committee qualitatively synthesized the evidence, with attention given to the overarching themes or key concepts from the findings, similarities and differences between studies, and factors that may have affected the results. The Committee developed conclusion statements and graded the strength of evidence based on its consistency, precision, risk of bias, directness and generalizability.

Results

Structured feeding practices (Monitoring)

Conclusion statement and grade

• Food parenting practices involving monitoring of children's eating by caregivers of children ages 2 to 6 years is not associated with outcomes related to growth. This conclusion statement is based on evidence graded as limited. (Grade: Limited)

Summary of the evidence

• Fifteen articles examined food parenting practices involving monitoring of children’s eating and growth, body composition and risk of obesity. All 15 studies were prospective cohort studies.
• The direction of results and effect size were similar across studies.
• Variation around the effect estimates were wide across studies.
• Few studies were designed and conducted well.
• The exposures and outcome measures that were examined directly represent those of interest in the review.
• The evidence may not apply to the U.S. population.

Structured feeding practices (Other)

Conclusion statement and grade

• A conclusion statement cannot be drawn about the relationship between food parenting practices by caregivers of children ages 2 to 6 years that structure children's physical and social eating environments (e.g., availability of healthy foods, modeling of healthy eating behaviors, meal routines such as eating together as a family) and outcomes related to growth, body composition, and risk of obesity because there was not enough evidence available. (Grade: Grade Not Assignable) ​

Summary of the evidence

• Seven articles examined other structured feeding practices and growth, body composition and risk of obesity. All 7 studies were prospective cohort studies.
• The 2025 Committee was not able to draw a conclusion due to critical limitations in the body of evidence.

Controlling feeding practices

Conclusion statement and grade

• A conclusion statement cannot be drawn about the relationship between controlling feeding practices by caregivers of children ages 2 to 6 years and outcomes related to growth, body composition, and risk of obesity because there are substantial concerns with consistency in the body of evidence. (Grade: Grade Not Assignable)

Summary of the evidence

• Twenty-eight articles examined controlling feeding practices and growth, body composition and risk of obesity. All 28 studies were prospective cohort studies.
• The 2025 Committee was not able to draw a conclusion due to critical limitations in the body of evidence.

Autonomy supportive feeding practices

Conclusion statement and grade

• A conclusion statement cannot be drawn about the relationship between food parenting practices by caregivers of children ages 2 to 6 years that provide developmentally appropriate support for children's autonomy (e.g., responsive feeding, praise, child involvement in food and eating activities) and outcomes related to growth, body composition, and risk of obesity because there are few studies and substantial concerns with consistency in the body of evidence. (Grade: Grade Not Assignable)

Conclusion statement and grade

• Five articles examined autonomy supportive feeding practices and growth, body composition and risk of obesity. All 5 studies were prospective cohort studies.
• The 2025 Committee was not able to draw a conclusion due to critical limitations in the body of evidence.

Feeding styles

Conclusion statement and grade

• A conclusion statement cannot be drawn about the relationship between feeding styles by caregivers of children ages 2 to 6 years and outcomes related to growth, body composition, and risk of obesity because there are substantial concerns with consistency in the body of evidence. (Grade: Grade Not Assignable)

Summary of the evidence

• Nine articles examined feeding styles and growth, body composition and risk of obesity. All 9 studies were prospective cohort studies.
• The 2025 Committee was not able to draw a conclusion due to critical limitations in the body of evidence.

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Suggested citation: Fisher JO, Eicher-Miller HA, Odoms-Young A, Palacios C, Abrams SA, Andres A, Byrd-Bredbenner C, Deierlein A, Lawless, M, Momin S, Butera G, Higgins M, Terry N, Obbagy J. Parental and Caregiver Feeding Styles and Practices and Growth, Body Composition and Risk of Obesity: A Systematic Review. November 2024. U.S. Department of Agriculture, Food and Nutrition Service, Center for Nutrition Policy and Promotion, Nutrition Evidence Systematic Review. Available at: https://doi.org/10.52570/NESR.DGAC2025.SR19