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

Am J Clin Nutr. 2016 Jul;104(1):143-54. doi: 10.3945/ajcn.115.123372. Epub 2016 May 18.


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.

Design: 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).

Conclusion: 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 as NCT02725970.

Keywords: BMI; Dietary Guidelines for Americans; HEALTH; barriers; facilitators.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Body Mass Index*
  • Body Weight*
  • Caregivers*
  • Child
  • Child Behavior*
  • Cross-Sectional Studies
  • Diet Surveys
  • Diet*
  • Ethnicity
  • Exercise
  • Feeding Behavior*
  • Female
  • Humans
  • Life Style
  • Male
  • Middle Aged
  • Nutrition Policy
  • Obesity / prevention & control
  • United States

Associated data