Child fussy eating and body composition

Fussy (or “picky”) eating behaviour is common in childhood and a source of concern for parents. Fussy eaters are characterised by their consistent rejection of certain foods – particularly vegetables – often resulting in a restricted dietary variety. It is possible that fussy eaters have an insufficient energy intake, resulting in underweight. However, fussy eaters may also compensate for their limited intake of vegetables and other disliked foods by eating more palatable, energy-dense foods, giving them a relatively high energy intake. Therefore, we aimed to study whether fussy eating at 4 years of age predicted children’s body mass over time. We also explored whether fussy eaters differ from non-fussy eaters in their fat mass and lean mass at 6 years.

This study* was embedded in Generation R, a large study that has been tracking the health and wellbeing of children from conception until childhood and onwards. Generation R is conducted by the Erasmus Medical Centre in Rotterdam, the Netherlands. To classify whether children were fussy eaters at age 4 or not, we used a fussy eating profile. This profile was not only characterized by food refusals, but also by slow eating and lack of enjoyment of food, and might therefore indicate severe fussy eaters. Of all 4191 children included in the study, about 6% were classified as fussy eaters according to this fussy eating profile.

Our main findings indicated that fussy eaters had a lower BMI at age 6, irrespective of the child’s BMI at age 4. This change in BMI was mainly due to a decrease in lean mass. Fussy eaters also had a higher risk of becoming underweight over a two-year period than non-fussy eaters.

Although fussy eating can be a normal phase of development, our findings highlight the possible adverse effect of more severe fussy eating on healthy growth. Health care practitioners should carefully monitor fussy eaters, particularly those who not only reject certain types of foods, but also show a pattern of slow and joyless eating. There is no golden standard yet for dealing with a fussy eater, but research suggests that parents should repeatedly offer their children a diversity of food items without pressuring their child to eat. Future researchers should follow fussy eaters over a longer period of time to study the potential long-term health consequences.

Lisanne de Barse
The Generation R Study Group, Erasmus MC-University Medical Center,
Department of Epidemiology, Erasmus MC-University Medical Center,
CA, Rotterdam, The Netherlands


Longitudinal association between preschool fussy eating and body composition at 6 years of age: The Generation R Study.
de Barse LM, Tiemeier H, Leermakers ET, Voortman T, Jaddoe VW, Edelson LR, Franco OH, Jansen PW.
Int J Behav Nutr Phys Act. 2015 Dec 14


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