Maternal restriction of children's eating and encouragements to eat as the 'non-shared environment': a pilot study using the child feeding questionnaire

Biopsychosocial pathways model of early childhood appetite self-regulation: Temperament as a key to modulation of interactions among systems

The widespread discrimination against individuals with obesity often stems from a simplistic perception of obesity as a mere consequence of personal choices of overeating and insufficient physical activity. This reductionist perception fails to acknowledge the complexity of the epidemic of obesity, which extends beyond diet and exercise decisions. The concept of appetite self-regulation (ASR) has been explored as a crucial element in identifying obesogenic behavioral approaches to food. Although an extensive understanding of ASR in children is essential as an early precursor and modifiable factor influencing obesity, the prevailing view of self-regulation of eating solely as a matter of cognitive and behavioral processing tends to overlook interacting systems of influences. This narrow approach attributes obesity to the lack of voluntary self-control in food consumption while neglecting to account for the biological, psychological, and social influences implicated in the developmental processes of ASR, which may further contribute to the stigmatization of obesity. The current critical analysis provides a comprehensive developmental framework that could guide future studies with testable hypotheses, outlining pathways of interactions among biopsychosocial systems, all of which contribute to the development of ASR in early childhood. Adopting developmental perspectives allows a holistic approach to investigating ASR, which accounts for intricate interactions between biological (B), psychological (P), and social (S) factors influential in the early manifestation of ASR.

Food Parenting Practices and Child Eating Behaviors in Australian Families: A Cross-Sectional Sibling Design

BACKGROUND

Research on feeding in early childhood has focused primarily on parent-child dyadic interactions, despite parents enacting these practices within the complex dynamic of the family system.

OBJECTIVE

Using a sibling design, this study aimed to assess how parents may adapt their food parenting practices for siblings in response to differences in their eating behaviors.

DESIGN

A cross-sectional online survey was conducted between October and December 2022.

PARTICIPANTS/SETTING

Data were collected from parents (97.5% women) in Australia with 2 children aged 2 to 5 years (n = 336 parents and n = 672 children).

MAIN OUTCOME MEASURES

Survey items were completed for each sibling, and included four subscales of the Children's Eating Behaviour Questionnaire and seven subscales of the Feeding Practices and Structure Questionnaire-28.

STATISTICAL ANALYSES PERFORMED

Multiple linear regression models examined associations between within-sibling pair differences in child eating behaviors and food parenting practices, adjusting for differences in child body mass index z score, age, gender, and early feeding method.

RESULTS

Within-sibling pair differences in eating behaviors were associated with differences in some food parenting practices. For the fussier sibling, parents reported using more control-based practices, including persuasive feeding, reward for eating, and reward for behavior, and less of the structure-based practice, family meal settings (P values < 0.001). Similar directions of associations were found for persuasive feeding, reward for eating, and family meal settings with siblings who were slower eaters or more satiety responsive (P values < 0.007); however, no significant differences in reward for behavior were observed in relation to sibling differences in these eating behaviors. For the more food responsive sibling, parents reported using more control-based practices, including reward for behavior and overt restriction (P values < 0.002).

CONCLUSIONS

Within families, parents may adapt certain practices in response to differences in their children's eating behaviors. Interventions promoting responsive feeding should be designed to acknowledge the integral role of siblings in shaping parents' feeding decisions.

Measurement is the foundation of research and theory on children's eating behaviours: Current issues and directions for progress

Eating behaviours affect food intakes and are involved in the aetiology of obesity. There has been impetus to translate findings about children's eating behaviour into intervention and policy programs. However, measurement limitations have hindered our capacity to understand and influence children's eating behaviours. In the present paper we provide an overview of some of the key methodological and measurement issues facing the field of children's eating behaviours and highlight implications for research and health promotion. Drawing on insight from parallel issues that occur in the measurement of early social and emotional development, we examine two overlapping themes in children's (aged 0-∼12 years) eating behaviours (Somaraki et al., 2021) measurement issues related to validity and reliability, and (Steinsbekk & Wichstrøm, 2015) associated methodological challenges, such as contextual influences and the importance of designing studies that use multiple informants and multiple methods. We then suggest insights and strategies aimed at advancing approaches to measurement of children's eating behaviours. To progress our understanding of children's eating behaviours, we conclude that a range of psychometrically sound, fit-for-purpose measurement instruments and procedures are needed for use in multi-trait, multi-method, multi-informant studies in a range of populations and contexts.

Infant appetite and weight gain in early infancy: Moderating effects of controlling feeding styles

Excessive infant weight gain is a strong predictor of later obesity. While controlling feeding has been linked to negative weight outcomes, research has not considered associations between infant appetite and maternal feeding simultaneously in relation to infant weight. This longitudinal study examined infant food responsiveness and slowness in eating as predictors of infant weight outcomes and tested controlling feeding styles (restrictive and pressuring) as moderators. Data came from a diverse sample of mothers and their infants participating in an ongoing longitudinal study. Mothers (n = 159) reported infant appetite and feeding styles at 2 postnatal timepoints (2-month visits and 6-month visits). The infant weight outcomes included change in weight-for-age z-scores (WAZ-change) and rapid weight gain (RIWG; WAZ-change ≥ 0.67 SD) from birth to the second postnatal visit. Data were analyzed using hierarchical multiple and logistic regressions, controlling for birthweight, gestational age, maternal race/ethnicity, feeding mode, and residing with an intimate partner. Over 25% of infants exhibited RIWG. Greater infant food responsiveness predicted both greater infant weight gain and RIWG status. Infant food responsiveness and slowness in eating interacted with controlling feeding styles in a unique way. Infants with higher food responsiveness whose mothers were less restrictive had greater weight gain (b = 0.61, p < 0.001) and increased probability of RIWG (b = 2.71, p < 0.01) than infants with more restrictive mothers. Higher slowness in eating was associated with a lower RIWG probability among infants of mothers with lower pressuring feeding (b = -1.86, p < 0.05). For infants with a large appetite, some level of restrictive feeding may be beneficial for preventing excessive weight gain while pressuring may exacerbate the positive association between faster eating and RIWG.

Disturbed families or families disturbed: a reconsideration

BACKGROUND

The relationship between anorexia nervosa (AN) and family disturbance has been a subject of debate since its first description. What began as a clear view of the pathologically disturbed family causing AN has become ever more complex over the decades.

OBJECTIVE

The aim of this review is to explore the literature to examine the changes and evolution of clinical opinion around family dysfunction and AN over the last 20 years.

METHODS

A narrative review of heterogeneous studies in peer-reviewed publications sourced from the major databases, including PubMed and ScienceDirect, to illuminate the topic of family distress and AN by highlighting the conflicting and complementary ways it has been studied.

RESULTS

This review has highlighted the complexity of the relationship between anorectic sufferers and their families. It has explored the literature about parental burden, emotions and cognitive mechanisms together with parental attitudes about weight and shape. It is clear that there is no consistent psycho-social pathology in families which has been shown to be causative. However, over the last twenty years, research has highlighted the distress and family dysfunction caused by having to look after an anoretic child with poor mentalisation skills, insecure attachment and emotion dysregulation.

CONCLUSION

The area has become clearer over the last 20 years; research suggests a bi-directional relationship between AN and family dysfunction, with difficult dynamics becoming entrenched within the family. This is best addressed, the consensus suggests, by specialist family therapy and carer skills interventions. Longitudinal research is needed to definitively answer the question with rigorous scientific certainty.

EMB RATING

Level V.

LEVEL OF EVIDENCE

Level I: Evidence obtained from: at least one properly designed randomized controlled trials; systematic reviews and meta-analyses; experimental studies. Level II: Evidence obtained from well-designed controlled trials without randomization. Level III: Evidence obtained from well-designed cohort or case-control analytic studies. Level IV: Evidence obtained from with multiple time series analysis such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence. Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Examining correlates of feeding practices among parents of preschoolers

Background: Parent feeding practices play a critical role in children's eating behaviors. Limited research has explored child-level correlates of parent feeding practices. Aim: To identify correlates of feeding practices (responsive and controlling) among parents of preschoolers US. Methods: Participants included parents (n = 273) of preschoolers (3-5 years), recruited from Early Care and Education settings (n = 24) located in a metropolitan city in the US. Analysis included descriptives, correlations, and multiple regression. Results: For responsive feeding practices, positive associations included child's weight with unintentional modeling (β = .17, 95% CI [0.12, 0.53]), child vegetable consumption with behavioral role modeling (β = 0.22, 95% CI [0.17, 0.44]), and parent monitoring with verbal modeling (β = 0.21, 95% CI [0.12, 0.34]). For controlling feeding practices, parent restriction was positively associated with child weight concern (β = 0.22, 95% CI [0.13, 0.39]) and parent monitoring (β = 0.13, 95% CI [0.01, 0.19]), whereas child vegetable consumption was negatively associated (β = -0.16, 95% CI [-0.27, -0.05]). Pressure to eat was negatively associated with child weight concern (β = -0.18, 95% CI [-0.45, -0.09]), child fruit consumption (β = -0.12, 95% CI [-0.37, -0.01]), household income (β = -0.13, 95% CI [-0.30, -0.02]), and parent weight (β = -0.14, 95% CI [-0.60, -0.05]), Conclusions: Findings highlight the importance of child characteristics when examining correlates of parent feeding practices, demonstrating bidirectional interactions between parent feeding practices and children's eating behaviors. Considering child-level correlates may improve the implementation of responsive feeding practices and reduce controlling feeding practices.

Intergenerational Transmission of Child Feeding Practices

This study assessed the relationships between parents’ retrospective recollections of their mothers’ child feeding practices (CFP), current disordered eating (DE) and current CFP (how they now feed their children). 174 Israeli parents (136 mothers, 38 fathers; 40.1 ± 6.9 years of age) of children between the ages of 2 and 18, living at home, completed questionnaires online assessing demographics, retrospective recollections of the CFP that their mothers used when they were children, current CFP and current DE. Specific aspects of retrospectively recalled maternal CFP were significantly associated with the same aspects of current CFP. Current DE mediated the association between retrospectively recalled maternal CFP and current CFP and moderated the association between current concern about child’s weight and pressure for child to eat. Results highlight that the way adults pass on their feeding practices to their children is strongly influenced by their childhood recollections of their mothers’ concern about their weight, pressure for them to eat or restriction of their food intake. People often strive to behave differently from their parents, especially in the realm of food and eating. However, our findings suggest that parental CFP can become entrenched and can be passed on to our children.

Learned Experience and Resource Dilution: Conceptualizing Sibling Influences on Parents' Feeding Practices

Studies from diverse cultures report mixed results in the relationship between birth order and risk for obesity. Explanations may thus lie in the postnatal period when growth is shaped by the family environment, including parental feeding practices, which may be affected by siblings. Consistent with a family systems perspective, we describe two processes that may explain birth order effects on parental feeding practices and child outcomes: learned experience and resource dilution. Parents learn from experience when earlier-born children influence their parents’ knowledge, expectations, and behavior toward later-born siblings through their behaviors and characteristics—which can have both positive and negative implications. Resource dilution is a process whereby the birth of each child limits the time, attention and other resources parents have to devote to any one of their children. The goal of this review is to provide a theoretical basis for examining potential sibling influences on parental responsive feeding toward developing recommendations for future research and practice aimed at preventing obesity throughout family systems.

Maternal perception, concern and dissatisfaction with child weight and their association with feeding practices in the Generation XXI birth cohort

What a mother thinks about her child's weight status might influence what and how she feeds her child. We examined the association between maternal perception, concern and dissatisfaction with child weight alongside feeding practices. Participants were from the Generation XXI birth cohort (n = 3233). A validated version of the Child Feeding Questionnaire and the Overt/Covert Control scale were used. Associations were evaluated by linear regression models (β coefficients and 95 % confidence intervals (95 % CI) with Bonferroni correction). Perceived underweight was associated with practices promoting food intake, such as higher pressure to eat at ages 4 and 7 years (β = 0·229; 95 % CI: 0·059, 0·398 and β = 0·190; 95 % CI:0·005, 0·376, respectively) and lower restriction at age 4 (β = -0·175; 95 % CI: -0·0310, -0·039). At age 7, perceived overweight was associated with higher covert control (β = 0·203; 95 % CI: 0·029, 0·376). Mothers who were concerned about child weight reported higher restriction (β = 0·226; 95 % CI: 0·142, 0·310 at 4 years and β = 0·261; 95 % CI: 0·169, 0·353 at 7 years) and covert control (β = 0·183; 95 % CI: 0·083, 0·282 at 4 years and β = 0·171; 95 % CI: 0·073, 0·269 at 7 years). Maternal desire for a heavier child was associated with higher pressure to eat at both ages (β = 0·285; 95 % CI: 0·163, 0·406 and β = 0·393; 95 % CI: 0·266, 0·520), while the desire for a thinner child was related to higher covert control at 7 years of age (β = 0·158; 95 % CI: 0·001, 0·316). Maternal perceptions and concern for child weight status are associated with feeding practices independently of actual weight status.

Weight discordant siblings' ability to reduce energy intake at a meal as compensation for prior energy intake from sugar-sweetened beverages (SSBs)

BACKGROUND

Insufficient compensation for energy from sugar-sweetened beverages (SSBs) consumed prior to meals may promote greater overall energy intake. If so, ability to compensate for prior energy intake may account for difference in adiposity between adolescents with and without overweight. Studies of fraternal siblings discordant for weight status control for some genetic and shared within-family factors, which allows for testing how putative non-shared factors, such as parental control of feeding, predicts sibling weight differences.

AIM

To determine whether same-sex weight-discordant (one with, one without overweight) adolescent siblings differ in ability to compensate for prior energy intake.

METHODS

Same-sex biological sibling pairs (mean age = 15.4; 95% confidence interval (CI) 15.1, 15.7) (n = 38 pairs; 21 male pairs) consumed a sugar-sweetened (450 kcal) or a non-nutritive-sweetened (10 kcal) liquid preload of equal volumes on separate days, followed by an ad libitum lunch. Multilevel models examined ability to compensate, dietary restraint, and parental control of child's feeding.

RESULTS

Siblings showed insufficient compensation and overate (with overweight = 44 kcal; without overweight = 32 kcal). Siblings shared little within-family similarity in compensation (intra-class correlation coefficient (ICC) = 0.20). Compensation was predicted by parental restriction and general restriction (p = 0.02) Differences in siblings' BMI z-scores were associated with differences in dietary restraint (p = 0.04) not with differences in compensation.

CONCLUSION

Sibling differences in compensation for energy from sweetened beverages were not associated with differences in their adiposity. Compensation may be determined by a constellation of factors, including age, parental feeding practices, and food characteristics.

Two to Tango? The Dance of Maternal Authority and Feeding Practices with Child Eating Behavior

The purpose of this study was to elucidate the relationship between maternal feeding practices and children’s eating problems. Mothers of 292 children aged 5.9 ± 1.1, 50% boys, reported online on parental authority, overt and covert control of the child’s food choices, child feeding practices, and their child’s problematic eating behavior. Structural equation modelling yielded a model with excellent indices of fit (χ⁽²⁾₍₅₂₎ = 50.72, p = 0.56; normed fit index (NFI) = 0.94; root mean square error of approximation (RMSEA) = 0.001). The model showed that an authoritarian maternal authority style was associated with overt control, which was associated with maternal tendency to pressure children to eat and with maternal restriction of highly processed or calorie-rich snack foods. These, in turn, were positively associated with the child’s satiety response, food fussiness, and slow eating, and negatively with the child’s enjoyment of food. In contrast, a permissive maternal authority style was associated with covert control of the child’s eating, concern over the child being overweight, and the restriction of highly processed and calorie-rich snack foods, which were in turn positively associated with the child’s emotional overeating and the child’s food responsiveness. The model seems to tap into two distinct patterns of mother-child feeding and eating dynamics, apparently related to children with opposing appetitive tendencies.

Appetitive Traits and Weight in Children: Evidence for Parents' Controlling Feeding Practices as Mediating Mechanisms

Children's food approach and food avoidance are appetitive traits with genetic or biological bases. Nonetheless, parents play a critical role in children's dietary intake through parenting and feeding practices. The present study tested parents' controlling feeding practices (i.e., restriction and pressure to eat) as mediating mechanisms between child appetitive traits and child BMI in an economically and ethnically diverse sample. Participants were 139 children aged 4 to 6 years (51.8% males, M = 4.77 years, SD = 0.84) and their parents. Results showed that restriction and pressure to eat mediated the relation between child food approach or food avoidance and child BMI. Mediation effects did not differ across poverty status or racial/ethnic groups. Also, the type of controlling feeding that parents exert related to children's weight status in diametrically different or opposite ways. Thus, food-related parenting appears to be a promising point of entry for childhood obesity prevention programs. Findings are consistent with a biopsychosocial model of the development of eating and weight in childhood which takes into account both parent and child behavior and characteristics and links child biology and behavior with psychosocial processes and environment.

Sweet at birth, bitter in growth

Complementary feeding plays a primary role in the life of an infant, as long as the correct assumption of nutrients in terms of timing and quality is the key to a healthy growth. Since infants are totally dependent on their parents during complementary feeding, educational programmes and intervention plans are needed to educate parents and caregivers. As to this, children's sugar consumption throughout their life has been specifically investigated and several critical points have been detected, demonstrating how sugar intake should not be higher than necessary in children and should not include sweetened beverages in daily nutrition. The association between children's diet and the subsequent consequences in their later life has been extensively studied, pointing out how countries should invest in policies that aim at decreasing sugar intake and encouraging parents, as well as children, to a healthier behaviour. The aim of this article is to look at the problem from three different perspectives, the parents' one, the scientific one, and the paediatrician one, in order to offer a new insight on the future of complementary feeding.

A biopsychosocial approach to processes and pathways in the development of overweight and obesity in childhood: Insights from developmental theory and research

Childhood obesity has reached alarming proportions in many countries. There is consensus that both biological (especially genetic) and environmental (including psychosocial) factors contribute to weight gain and obesity in childhood. Research has identified extensive risk or predictive factors for childhood obesity from both of these domains. There is less consensus about the developmental processes or pathways showing how these risk factors lead to overweigh/obesity (OW/OB) in childhood. We outline a biopsychosocial process model of the development of OW/OB in childhood. The model and associated scholarship from developmental theory and research guide an analysis of research on OW/OB in childhood. The model incorporates biological factors such as genetic predispositions or susceptibility genes, temperament, and homeostatic and allostatic processes with the psychosocial and behavioral factors of parenting, parental feeding practices, child appetitive traits, food liking, food intakes, and energy expenditure. There is an emphasis on bidirectional and transactional processes linking child biology and behavior with psychosocial processes and environment. Insights from developmental theory and research include implications for conceptualization, measurement, research design, and possible multiple pathways to OW/OB. Understanding the developmental processes and pathways involved in childhood OW/OB should contribute to more targeted prevention and intervention strategies in childhood.

About feeding children: factor structure and internal reliability of a survey to assess mealtime strategies and beliefs of early childhood education teachers

BACKGROUND

Children spend a substantial amount of time in early care and education (ECE) settings and may eat a majority of their diet in this setting. While there are several instruments focused on measuring factors of the ECE environment that may influence diet and weight outcomes, there are few comprehensive, valid, and reliable measures for collecting self-report of ECE providers' feeding practices. The purpose of this study was to establish the factor structure and internal reliability of a survey developed to measure practices and beliefs of ECE providers relative to feeding children.

METHODS

Licensed ECE centers from CA, CO, ID and NV were included in this cross-sectional survey study. The sample was stratified by states and census regions to yield equal numbers of centers from each category. The total sample distribution included 1600 randomly selected centers and up to 8000 staff members (who represented teachers, aides, assistants, or cooks); 1178 surveys were completed. We conducted an exploratory, unrestricted factor analysis as well as parallel analyses to inform the number of factors to be extracted.

RESULTS

Factors within Structural Mealtime Strategies included Adult Control of Foods Consumed (Kuder-Richardson [KR] = 0.67), Bribing with Sweet Foods (KR = 0.70), and Supportive Adult Roles at Mealtime (KR = 0.55). Factors in Verbal Mealtime Strategies included Supporting Children's Eating Self-regulation (KR =0.61), Pressure to Eat (KR = 0.58), and Social Comparisons (KR = 0.59). Beliefs about Mealtime factors were Autonomy Promoting (α = 0.64), Coercive Beliefs (α = 0.77), and Concern-Based Control (α = 0.60).

CONCLUSIONS

The AFC Strategies and Beliefs Survey provides a promising self-report instrument with a strong factor structure consistent with the extant literature to measure practices and beliefs related to feeding and mealtimes in the ECE setting. Feeding young children in group settings differs in many ways from feeding in a family setting; hence it is important that measures such as the AFC Strategies and Beliefs Survey capture unique aspects of the ECE feeding environment.

Biological and Psychosocial Processes in the Development of Children's Appetitive Traits: Insights from Developmental Theory and Research

There has been increasing concern expressed about children's food intakes and dietary patterns. These are closely linked to children's appetitive traits (such as disinhibited eating and food fussiness/neophobia). Research has examined both biological and psychosocial correlates or predictors of these traits. There has been less focus on possible processes or mechanisms associated with children's development of these traits and research that links biological and psychosocial factors. There is an absence of research that links biological and psychosocial factors. In the present article, we outline a model intended to facilitate theory and research on the development of appetitive traits. It is based on scholarship from developmental theory and research and incorporates biological factors such as genetic predispositions and temperament as well as psychosocial factors in terms of parent cognitions, feeding styles and feeding practices. Particular attention is directed to aspects such as emotional eating and feeding, self-regulation of energy intake, and non-shared family environments. We highlight the opportunity for longitudinal research that examines bidirectional, transactional and cascade processes and uses a developmental framework. The model provides a basis for connecting the biological foundations of appetitive traits to system-level analysis in the family. Knowledge generated through the application of the model should lead to more effective prevention and intervention initiatives.

Significant differences in maternal child-feeding style between ethnic groups in the UK: the role of deprivation and parenting styles

BACKGROUND

Nonresponsive maternal child-feeding interactions, such as restricting, pressurising and emotional feeding, can affect the ability of a child to self-regulate intake and increase the risk of becoming overweight. However, despite findings that South Asian and Black children living in the UK are more likely to be overweight, UK research has not considered how maternal child-feeding style might differ between ethnic groups. The present study aimed to explore variations in maternal child-feeding style between ethnic groups in the UK, taking into account associated factors such as deprivation and parenting style.

METHODS

Six hundred and fifty-nine UK mothers with a child who was aged 5-11 years old completed a questionnaire. Items included ethnicity and demographic data, as well as copies of the Child Feeding Questionnaire, Parental Feeding Styles Questionnaire and Parenting Styles and Dimensions Questionnaire.

RESULTS

Significant differences in perceived responsibility (P = 0.002), restriction (P = 0.026), pressure to eat (P = 0.045), instrumental feeding (P = 0.000) and emotional feeding (P = 0.000) were found between the groups. Mothers from South Asian backgrounds reported higher levels of pressure to eat, emotional feeding and indulgent feeding styles, whereas mothers from Chinese backgrounds reported greater perceived responsibility and restriction. Mothers from Black and White British backgrounds were not significantly higher with respect to any behaviour. Maternal child-feeding style was also associated with deprivation and parenting style, although these did not fully explain the data.

CONCLUSIONS

Understanding cultural factors behind maternal child-feeding style, particularly around pressurising and indulgent feeding behaviours, may play an important part in reducing levels of children who are overweight and obese in the UK.

Friends and social contexts as unshared environments: a discordant sibling analysis of obesity- and health-related behaviors in young adolescents

OBJECTIVE

This study examines the contribution of best friends' weight and the peer social context (time spent alone versus with friends) as sources of unshared environment associated with variability in weight and health behaviors among weight-discordant siblings.

METHODS

Pairs of same-sex biologic siblings (N=40 pairs; ages 13-17) were originally recruited as part of a study evaluating putative factors contributing to differences in adiposity among weight-discordant siblings. Siblings were asked to bring their best friends to the laboratory and siblings and friends' height and weight were objectively measured. Siblings also completed multi-pass dietary recalls to assess energy intake and sugar sweetened beverage (SSB) consumption. Siblings' physical activity was measured using accelerometry. Experience sampling methodology was used to assess sedentary behaviors/screen time and the number of occasions siblings spent alone and in the presence of friends. Multilevel models were used to estimate the relationships between predictors (best friends' zBMI, time spent alone or with friends) and outcomes (siblings' zBMI and obesity-related health behaviors).

RESULTS

Best friends' zBMI was the best predictor of participants' zBMI, even when controlling for child's birth weight. Best friends' weight (zBMI) further predicted participants' SSB intake and time engaged in sedentary behaviors. Being active with friends was positively associated with participants' overall physical activity, whereas spending time alone was negatively associated with accelerometer counts regardless of siblings' adiposity.

CONCLUSIONS

A friends' weight and the social context are unshared environmental factors associated with variability in adiposity among biologically-related weight-discordant siblings.

A Qualitative Investigation of Parents' Perspectives About Feeding Practices With Siblings Among Racially/Ethnically and Socioeconomically Diverse Households

OBJECTIVE

Little is known about parent feeding practices with siblings. Because this is a new area of research, qualitative research is needed to understand parents' perspectives about how they make decisions about feeding siblings and whether they adapt their feeding practices dependent on sibling characteristics such as weight status. The main objective of the current study was to describe parent feeding practices with siblings.

DESIGN

Qualitative cross-sectional study with 88 parents with at least 2 siblings.

SETTING

Parents were interviewed in their homes in Minneapolis/St Paul Minnesota.

PARTICIPANTS

Parents were from racially/ethnically diverse (64% African American) and low-income households (77% earned < $35,000/y).

MAIN OUTCOME MEASURE

Parents' perceptions of feeding practices with siblings.

ANALYSIS

Qualitative interviews were coded using a hybrid deductive and inductive content analysis approach.

RESULTS

Parents indicated that they used child food preferences, in-the-moment decisions, and planned meals when deciding how to feed siblings. Additionally, the majority of parents indicated that they managed picky eating by making 1 meal or giving some flexibility/leeway to siblings about having other food options. Furthermore, parents endorsed using different feeding practices (eg, food restriction, portion control, pressure-to-eat, opportunities for healthful eating) with siblings dependent on child weight status or age/developmental stage.

CONCLUSIONS AND IMPLICATIONS

Findings from the current study may inform future research regarding how to measure parent feeding practices with siblings in the home environment and the development of interventions tailored for families with multiple children in the home. Future quantitative research is needed to confirm these qualitative findings.

Sibling eating behaviours and parental feeding practices with siblings: similar or different?

OBJECTIVE

Little is known about whether siblings have similar or different eating behaviours or whether parents tailor their feeding practices to different siblings. The main objectives of the present study were to examine similarities and differences in child eating behaviours and parental feeding practices with siblings and to determine whether child eating behaviours and parental feeding practices differ depending on sibling concordant (i.e. both siblings overweight or healthy weight) or discordant (i.e. one sibling overweight and one sibling healthy weight) weight status.

DESIGN

Cross-sectional, mixed-methods study.

SETTING

In-home visits were conducted by research staff. Surveys were conducted with parents and anthropometry was collected on parents and siblings.

SUBJECTS

Children (n 88) aged 6-12 years (mean age 9 (sd 2) years), their parents (mean age 34 (sd 7) years) and near-age siblings (mean age 9 (sd 4) years) from diverse racial/ethnic and low-income households participated.

RESULTS

Results indicated that siblings with higher BMI engaged in higher levels of emotional eating compared with siblings with lower BMI. Additionally, results indicated that when families had sibling dyads discordant on weight status, the sibling who was overweight had higher food enjoyment and lower levels of food satiety. Additionally, within siblings with discordant weight status, parents were more likely to use restrictive feeding practices with the overweight sibling and pressure-to-eat and encouragement-to-eat feeding practices with the healthy-weight sibling.

CONCLUSIONS

Family-based childhood obesity interventions may need to assess for sibling weight status when researching the home environment and intervene with parents to avoid using restriction or pressure-to-eat feeding practices when siblings are discordant on weight status.

Do Parents Treat Siblings Similarly or Differently with Regard to Feeding Practices, Weight-Related Conversations, and Support for Physical Activity? An Exploratory Analysis

BACKGROUND

It is unknown if parents with more than one adolescent child use similar or different parenting practices of relevance to weight-related health with different children. In particular, it is unclear whether parenting practices differ based on whether siblings are discordant on weight status (i.e., one is overweight/obese, one is nonoverweight/obese) or are different sexes.

METHODS

Data from two linked population-based studies, Eating and Activity in Teens (EAT) 2010 and Families and Eating and Activity in Teens (F-EAT), were used in this exploratory cross-sectional analysis. Participants included socioeconomically and racially/ethnically diverse parents (n = 57; 93% females) and adolescent siblings (n = 57 pairs; 60% girls; mean age = 14.5, range = 11-18). Students filled out surveys and had anthropometric measures taken in school. Parents filled out mailed surveys in their homes.

RESULTS

Overall, results from this exploratory study showed limited evidence that parents use different parenting practices with adolescents of different weight status or sex. However, potentially important patterns emerged when exploring parenting practices and siblings' weight status. For example, within sibling dyads with discordant weight status, parents reported significantly more negative weight-related conversations with overweight/obese siblings compared to nonoverweight/obese siblings (p < 0.05). Although observed differences were not statistically significant, parents also reported higher levels of food restriction (p = 0.05) and encouragement to diet (p = 0.07) with overweight/obese siblings compared to nonoverweight/obese siblings. There were no significant differences in parenting practices by adolescent sex.

CONCLUSIONS

Results generally suggest that parents use similar parenting practices with adolescent siblings. However, notable patterns emerged when examining parenting practices and siblings' weight status that may be important to explore in future research.

Associations between Parental Concerns about Preschoolers' Weight and Eating and Parental Feeding Practices: Results from Analyses of the Child Eating Behavior Questionnaire, the Child Feeding Questionnaire, and the Lifestyle Behavior Checklist

Introduction

Insight into parents’ perceptions of their children’s eating behaviors is crucial for the development of successful childhood obesity programs. However, links between children’s eating behaviors and parental feeding practices and concerns have yet to be established. This study aims to examine associations between parental perceptions of preschoolers’ eating behaviors and parental feeding practices. First, it tests the original 8-factor structure of the Child Eating Behavior Questionnaire (CEBQ). Second, it examines the associations with parental feeding practices, measured with the Child Feeding Questionnaire (CFQ).

Materials and Methods

Questionnaires were sent to parents from 25 schools/preschools in Stockholm, Sweden and to parents starting a childhood obesity intervention. The CEBQ factor structure was tested with confirmatory factor analysis (CFA). Associations between CEBQ subscales Food approach and Food avoidance and CFQ factors Restriction, Pressure to eat and Monitoring were examined with structural equation modelling (SEM), adjusting for child and parental characteristics, and parental confidence, measured with the Lifestyle Behavior Checklist (LBC). CFQ Concern for child weight and Perceived responsibility for child eating were used as mediators.

Results

478 parents completed the questionnaires (children: 52% girls, mean age 5.5 years, 20% overweight/obese). A modified 8-factor structure showed an acceptable fit (TLI = 0.91, CFI = 0.92, RMSEA = 0.05 and SRMR = 0.06) after dropping one item and allowing three pairs of error terms to correlate. The SEM model demonstrated that Food approach had a weak direct effect on Restriction, but a moderate (β = 0.30) indirect effect via Concern, resulting in a substantial total effect (β = 0.37). Food avoidance had a strong positive effect on Pressure to eat (β = 0.71).

Discussion

The CEBQ is a valid instrument for assessing parental perceptions of preschoolers’ eating behaviors. Parental pressure to eat was strongly associated with children’s food avoidance. Parental restriction, however, was more strongly associated with parents’ concerns about their children’s weights than with children’s food approach. This suggests that childhood obesity interventions should address parents’ perceptions of healthy weight alongside perceptions of healthy eating.

Pilot Study of a Computer-Based Parental Questionnaire and Visual Profile of Obesity Risk in Healthy Preschoolers

PURPOSE

This group field-tested a computer-based, parental questionnaire entitled the Childhood Obesity Risk Questionnaire 2-5 (CORQ 2-5) designed to assess obesity risk in healthy preschoolers. COR 2-5 generates a profile of seven obesity risk factors.

RESULTS

Field studies provided good internal reliability data and evidence of discriminant validity for the CORQ 2-5. Pediatric nurse clinicians found the CORQ 2-5 profile to be clinically relevant.

CONCLUSION

The CORQ 2-5 is a promising measure of obesity risk in preschoolers who attend community-based health centers for their wellchild visits and who are not yet obese. CORQ 2-5 is intended to guide provider-parental obesity risk discussions.

Confirmatory factor analysis and measurement invariance of the Child Feeding Questionnaire in low-income Hispanic and African-American mothers with preschool-age children

Validation work of the Child Feeding Questionnaire (CFQ) in low-income minority samples suggests a need for further conceptual refinement of this instrument. Using confirmatory factor analysis, this study evaluated 5- and 6-factor models on a large sample of African-American and Hispanic mothers with preschool-age children (n = 962). The 5-factor model included: 'perceived responsibility', 'concern about child's weight', 'restriction', 'pressure to eat', and 'monitoring' and the 6-factor model also tested 'food as a reward'. Multi-group analysis assessed measurement invariance by race/ethnicity. In the 5-factor model, two low-loading items from 'restriction' and one low-variance item from 'perceived responsibility' were dropped to achieve fit. Only removal of the low-variance item was needed to achieve fit in the 6-factor model. Invariance analyses demonstrated differences in factor loadings. This finding suggests African-American and Hispanic mothers may vary in their interpretation of some CFQ items and use of cognitive interviews could enhance item interpretation. Our results also demonstrated that 'food as a reward' is a plausible construct among a low-income minority sample and adds to the evidence that this factor resonates conceptually with parents of preschoolers; however, further testing is needed to determine the validity of this factor with older age groups.

Systematic research review of observational approaches used to evaluate mother-child mealtime interactions during preschool years

BACKGROUND

The family meal and social interactions during the meal are important events in a child's life. Specifically, mealtime interactions have been linked to child weight status, the development of children's eating patterns, and socialization. Mealtime interactions may be observed and evaluated to provide insights into this important event beyond self-reported measurements.

OBJECTIVE

We aimed to identify, review, and examine studies in which mother-child mealtime behaviors were measured through observation.

DESIGN

MEDLINE Complete, PsycINFO, and PsycARTICLES were systematically searched by using sensitive search strategies. We included observational studies of mother-child eating and mealtimes and associations between mother-child interactions and preschool child eating or weight status published to March 2014.

RESULTS

Thirteen articles were included in our review. All studies but one were cross-sectional, and none of the studies evaluated how mutual dimensions (e.g., parent responsiveness to the child and child responsiveness to the parent) of dyadic interactions between mothers and children influence maternal feeding practices, children's eating, and weight. The parenting style was associated with maternal feeding practices but not directly with children's eating. Parental discouragements to eat and negative statements about food were associated with higher child weight status. Parental encouragement to eat was associated with higher child weight status as well as maternal body mass index. No associations were shown between maternal reports of feeding practices and observed maternal feeding practices.

CONCLUSIONS

Parents' overarching attitudes and approaches to parenting appear to be associated with their feeding practices or styles. Future studies should implement longitudinal observational methods with the capacity to measure levels of dimensions within bidirectional parent-child interactions and the extent to which these factors influence maternal practices, children's eating, and weight status.

Differential maternal feeding practices, eating self-regulation, and adiposity in young twins

OBJECTIVE

Restrictive feeding is associated with childhood obesity; however, this could be due to other factors that drive children to overeat and parents to restrict (eg, child genetics). Using a twin design to better control for confounders, we tested differences in restrictive feeding within families in relation to differences in twins' self-regulatory eating and weight status.

METHODS

Sixty-four same-gender twin pairs (4-7 years old) were studied with their mothers. Child caloric compensation ability (COMPX% index) was assessed by using a laboratory-based protocol. The Child Feeding Questionnaire assessed mothers' self-reported feeding styles toward each twin. Child BMI (kg/m(2)) and BMI z score were calculated by using measured weight and height; percent body fat and waist circumference were also assessed. Partial correlations examined within-twin pair differences in Child Feeding Questionnaire subscales in relation to within-twin pair differences in anthropometry and caloric compensation (COMPX%).

RESULTS

Differences in maternal restriction were significantly associated with within-pair differences in child COMPX% and BMI z score. Mothers reported more restriction toward the heavier and more poorly compensating twin. Additionally, within-pair differences in parental pressure to eat were associated with significant differences in BMI z score, percent body fat, and waist circumference. Mothers were more pressuring toward the lighter twin.

CONCLUSIONS

Mothers vary in their feeding practices, even among same-gender twin pairs, which might influence differences in adiposity. Future research needs to elucidate cause-and-effect and intervention implications regarding parental restriction and pressure-to-eat prompts.

Predictors of caregiver feeding practices differentiating persistently obese from persistently non-overweight adolescents

Understanding the contribution of caregiver feeding practices to adolescent diet and weight is important to refining caregiver roles within the context of adolescent obesity prevention and treatment. This secondary data analysis examined whether feeding practices of female caregivers differentiated persistently non-overweight (n = 29) from persistently obese (n = 47) adolescents. Families who previously participated in a cross-sectional study on correlates of obesity were recruited for this follow-up study. At the time of the follow-up study, anthropometric measures were taken for all female caregivers and adolescents, and caregivers completed the Child Feeding Questionnaire-Adolescent version. Socioeconomic, demographic, female caregiver anthropometric, and psychological (caregiver perceived self-weight and concern for adolescent overweight) variables were examined as predictors of feeding practices found to differentiate the two groups. Female caregivers of persistently obese adolescents reported significantly greater use of restriction and monitoring compared to female caregivers of persistently non-overweight adolescents. Restriction was predicted by female caregiver age and concern for adolescent overweight whereas monitoring was predicted by concern for adolescent overweight only. Caregiver feeding strategies may be an important target for adolescent obesity prevention and intervention efforts particularly among those with heightened concern about their teen's weight status.

Parental feeding practices and associations with child weight status. Swedish validation of the Child Feeding Questionnaire finds parents of 4-year-olds less restrictive

The Child Feeding Questionnaire (CFQ) assesses parental feeding attitudes, beliefs and practices concerned with child feeding and obesity proneness. The questionnaire has been developed in the U.S., and validation studies in other countries are limited. The aim of this study was to examine the psychometric properties of the CFQ in Sweden and the associations between parenting practices and children's weight status. Based on records from the Swedish population register, all mothers of 4-year-olds (n = 3007) from the third largest city in Sweden, Malmö, were contacted by mail. Those who returned the CFQ together with a background questionnaire (n = 876) received the CFQ again to enable test-retest evaluation; 564 mothers completed the CFQ twice. We used confirmatory factor analysis to test whether the original 7-factor model was supported. Good fit (CFI = 0.94, TLI = 0.95, RMSEA = 0.04, SRMR = 0.05) was obtained after minor modifications such as dropping 2 items on restriction and adding 3 error covariances. The internal reliability and the 2-week test-retest reliability were good. The scores on restriction were the lowest ever reported. When the influence of parenting practices on child BMI (dependent variable) was examined in a structural equation model (SEM), child BMI had a positive association with restriction and a negative association with pressure to eat. Restriction was positively influenced by concern about child weight. The second SEM treated parenting practices as dependent variables. Parental foreign origin and child BMI had direct effects on restriction, while pressure to eat was also influenced by parental education. While the results of the study support the usefulness of the CFQ in Sweden, carefully designed cross-cultural comparisons are needed to explain why the levels of restrictive feeding in Swedish families are the lowest reported.

Relationship between impulsivity, snack consumption and children's weight

BACKGROUND

Childhood overweight is a public health problem associated with psychosocial and physical problems. Personality traits, such as impulsivity, may contribute to the development of overweight.

OBJECTIVE

This study examines 1) the association between general impulsivity traits (reward sensitivity and disinhibition) and children's weight, 2) the association between impulsivity traits and unhealthy snack consumption, and 3) the potential mediating role of unhealthy snack consumption in the relationship between impulsivity traits and children's weight.

METHODS

Included were 1,377 parent-child dyads participating in the IVO Nutrition and Physical Activity Child cohorT (INPACT). Children had a mean age of 10 years. Parents completed a questionnaire to measure children's unhealthy snack consumption. Children completed a door-opening task to assess reward sensitivity and completed a questionnaire to measure disinhibition. Children's height and weight were measured to calculate their BMI z-scores. Cross-sectional linear regression analyses were performed to test the associations.

RESULTS

Disinhibition was positively associated with unhealthy snack consumption but not with BMI z-scores. Reward sensitivity was not related to unhealthy snack consumption or to BMI z-scores.

CONCLUSIONS

No evidence was found for a mediating effect of unhealthy snack consumption in the relation between impulsivity traits and children's weight. However, disinhibition appears to have a negative influence on children's unhealthy snack consumption. Future research focusing on food-related impulsivity in addition to general impulsivity will provide additional insight into factors that influence children's unhealthy snack consumption and weight.

Persistently obese youth: interactions between parenting styles and feeding practices with child temperament

OBJECTIVE

To assess the interaction of parent and child characteristics with feeding practices and mealtime functioning.

DESIGN

Longitudinal, predictive study comparing baseline characteristics with follow-up assessments.

PARTICIPANTS

The caregivers of 52 persistently obese youth and 32 nonoverweight comparison youth completed measurements of child temperament, parental feeding practices, parenting styles, and interactions during mealtimes.

RESULTS

Adolescents with persistent obesity were significantly more likely to be parented using problematic feeding practices when parents also reported difficult child temperaments. Additionally, adolescents with persistent obesity and difficult temperaments were significantly more likely to have lower levels of positive mealtime interactions.

CONCLUSION

Persistently obese youth are at increased risk for problematic parental feeding practices and mealtime functioning, particularly when youth are described as having difficult temperaments. These results indicate that further investigations are needed to better understand the mechanisms linking parent and child characteristics with health-related behaviors for adolescents with obesity.

Feeding Practices of Mothers from Varied Income and Racial/Ethnic Groups

OBJECTIVE

Relatively few investigators have explored the role of maternal control in describing the feeding behavior of nonwhite parents of preschool-age children. The present study was conducted to examine if controlling feeding behaviors (i.e., restriction and pressuring) varied by income (middle vs. low) and race/ethnicity (white vs. Hispanic), and if they were associated with the BMI of their 4-year-old offspring.

METHOD

Responses to the "restriction" and "pressure to eat" variables of the Child Feeding Questionnaire were compared between 51 white middle-income mothers and 49 Hispanic low-income mothers.

RESULTS

Mothers from both groups gave predominantly "neutral" ratings in their self-reports of feeding practices. However, relative to the Hispanic mothers, white mothers indicated significantly less restriction and pressure to eat. Higher child BMI was predicted by male gender and being Hispanic.

CONCLUSION

The utility of maternal feeding practices in predicting child overweight is discussed, and the significant association between the conceptually different constructs of restriction and pressure to eat is examined.

The Impact Of Parental Feeding Practices On Their Children’s Appetitive Traits: A Study Among Children Aged 5-11 Years Old In Dubai Private Schools

This study explores associations between parental feeding practices and childrens appetitive traits, putting to test the hypotheses that a) parental “restriction” is associated with having a child with stronger food approach tendencies (food enjoyment (FE) and food over responsiveness (FR)), and b) parental pressure to eat is associated with having a child with food avoidance tendencies (satiety responsiveness (SR),slowness in eating (SE) and food fussiness(FF)).The participants from 55 nationalities, targeting 1083 parents of 5-to 11-year-old children from 7 private schools in Dubai, UAE, who completed self-reported questionnaires over the 2011-2012 school year. The questionnaire has been a tailored amalgamation of CEBQ and CFQ in order to measure the children’s appetitive traits and parental feeding practices, respectively. The findings of this quantitative, descriptive, cross-sectional analysis confirmed the hypotheses in that “parental restriction” was positively associated with child food responsiveness (r, 0.183), and food enjoyment (r, 0.102). On the other hand, parental pressure to eat was positively associated with child satiety responsiveness (r,0.265), slowness (r, 0.253), and fussiness (r, 0.174) and negatively with food enjoyment (r, -0.214) and food responsiveness (r, - 0.142). To conclude, as far as the figures depict, the parents controlling their children’s food intake would seemingly a reverse impact on their eating behaviour in the short term.

Child food neophobia is heritable, associated with less compliant eating, and moderates familial resemblance for BMI

OBJECTIVE

The heritability of food neophobia, the tendency to avoid new foods, was tested in 4-7-year-old twins. We also examined whether food neophobia is associated with parent-child feeding relations or child body fat.

DESIGN AND METHODS

66 same-sex twin pairs, including 37 monozygotic (MZ) and 29 dizygotic (DZ) pairs were studied. Food neophobia was assessed by parent questionnaire (Child Food Neophobia Scale, CFNS), as were child-feeding practices and "division of responsibility" feeding relations. Child anthropometry and percent body fat were directly measured.

RESULTS

MZ and DZ twin pair correlations for food neophobia were r = 0.71 and r = -0.01, respectively: heritability= 72%. Greater food neophobia was associated with reduced child eating compliance of prompted foods (P < 0.001) reduced eating compliance of initially refused foods (P < 0.001), and--among girls only--fewer parental food demands (P = 0.01). Interestingly, the correlation between maternal BMI and child BMI z-score was significant only for children high (P = 0.03), but not low (P = 0.55), in food neophobia.

CONCLUSION

Child food neophobia, a highly heritable trait previously linked to emotionality, was associated with less compliant parent-child feeding relations. Strategies to combat food neophobia and foster more harmonious feeding relationships may have a role in obesity prevention.

Nothing gained: an explorative study of the long-term effects of perceived maternal feeding practices on women's and men's adult BMI, body image dissatisfaction, and disordered eating

The objective of the studies presented here was the prediction of adult body mass index (BMI), body image dissatisfaction, and disordered eating from recalled maternal child feeding practices. Studies 1 and 2 sampled women from the community, and found that recalled childhood feeding practices predicted both current BMI and current disordered eating. Daughters whose mothers pressured them to eat as children had lower BMIs as adults. The more a mother was concerned about her daughter's weight as a child, and the more she restricted fatty food intake, the less the woman was satisfied with her current body image. Disordered eating of adult women was positively related to their mothers' restriction of their fatty food intake as children, and negatively related to the mothers' monitoring of their food intake as children. Combining the samples and subdividing them into four BMI intervals showed that the obese women were higher on all but one of the recalled maternal child feeding practices, as well as on disordered eating and body dissatisfaction. Age was found to be positively related to BMI and drive for thinness, but not to body dissatisfaction or disordered eating, with older women having higher BMI and more drive for thinness. Study 3 sampled adult men from the community and found that recalled maternal child feeding practices predicted adult BMI and disordered eating for men, as well as for women. Considerable sex differences were found for all study variables. Recollection of maternal child feeding practices may have a formative role in the development of body image, disordered eating, and BMI for men and women, even into adulthood.

Clustering of diet- and activity-related parenting practices: cross-sectional findings of the INPACT study

Background

Various diet- and activity-related parenting practices are positive determinants of child dietary and activity behaviour, including home availability, parental modelling and parental policies. There is evidence that parenting practices cluster within the dietary domain and within the activity domain. This study explores whether diet- and activity-related parenting practices cluster across the dietary and activity domain. Also examined is whether the clusters are related to child and parental background characteristics. Finally, to indicate the relevance of the clusters in influencing child dietary and activity behaviour, we examined whether clusters of parenting practices are related to these behaviours.

Methods

Data were used from 1480 parent–child dyads participating in the Dutch IVO Nutrition and Physical Activity Child cohorT (INPACT). Parents of children aged 8–11 years completed questionnaires at home assessing their diet- and activity-related parenting practices, child and parental background characteristics, and child dietary and activity behaviours. Principal component analysis (PCA) was used to identify clusters of parenting practices. Backward regression analysis was used to examine the relationship between child and parental background characteristics with cluster scores, and partial correlations to examine associations between cluster scores and child dietary and activity behaviours.

Results

PCA revealed five clusters of parenting practices: 1) high visibility and accessibility of screens and unhealthy food, 2) diet- and activity-related rules, 3) low availability of unhealthy food, 4) diet- and activity-related positive modelling, and 5) positive modelling on sports and fruit. Low parental education was associated with unhealthy cluster 1, while high(er) education was associated with healthy clusters 2, 3 and 5. Separate clusters were related to both child dietary and activity behaviour in the hypothesized directions: healthy clusters were positively related to obesity-reducing behaviours and negatively to obesity-inducing behaviours.

Conclusion

Parenting practices cluster across the dietary and activity domain. Parental education can be seen as an indicator of a broader parental context in which clusters of parenting practices operate. Separate clusters are related to both child dietary and activity behaviour. Interventions that focus on clusters of parenting practices to assist parents (especially low-educated parents) in changing their child’s dietary and activity behaviour seems justified.

Sociocultural pressures and adolescent eating in the absence of hunger

Parental feeding practices and sociocultural pressures theoretically influence eating behavior. Yet, whether these factors relate to eating in the absence of hunger (EAH) is unknown. We assessed if sociocultural pressures were associated with EAH among 90 adolescents (Mage=15.27, SD=1.39; 48% female). Parents completed the Child Feeding Questionnaire. Adolescents completed the Perceived Sociocultural Pressures Scale, Sociocultural Attitudes Towards Appearance Questionnaire-3, and Multidimensional Body Self-Relations Questionnaire-Appearance Scales. On two occasions, EAH was assessed as snack food intake after adolescents ate to satiety. Controlling for body composition and demographics, parental restriction and family pressure to be thin were associated with greater EAH. Media pressure was related to more EAH in girls. Appearance orientation and preoccupation with becoming overweight mediated links between sociocultural pressures and EAH. Findings support the notion that sociocultural pressures and their links to body image may contribute to the course of disinhibited eating behaviors during adolescence.

Associations between parenting styles and nutrition knowledge and 2-5-year-old children's fruit, vegetable and non-core food consumption

OBJECTIVE

During the early years, parents have a major influence on children’s diets and developing food choices. We investigated parenting styles as predictors of 2–5-year-old children’s diets and whether general nutrition knowledge (GNK) mediated these influences.

DESIGN

Cross-sectional research. Questionnaires measured demographic and lifestyle variables, family environment, parenting styles and feeding practices, child diet and GNK. Regression models tested GNK as a mediator of relationships between parenting variables and child diet (fruit/vegetable and non-core food consumption), controlling for confounders and family environment.

SETTING

Questionnaires were completed by main caregivers at home.

SUBJECTS

Parents of children aged 2–5 years (n 269).

RESULTS

Higher child fruit/vegetable consumption was associated with lower overreactive parenting and restriction, higher authoritative parenting and dining together as a family; with lax parenting approaching statistical significance (P50?083) and 19% of variance explained by the model. GNK was not a significant predictor. Conversely, non-core food consumption was associated with higher over-reactive and lax parenting as well as child age, increased takeaway food consumption and higher television viewing; GNK had a small effect (P = 0.043) and 28% of variance was explained by the model. GNK was a significant mediator only for authoritative parenting on non-core food (effect = -0.005).

CONCLUSIONS

These findings highlight that young children’s diets may be improved by interventions targeting a range of positive and supportive parenting practices in conjunction with nutrition knowledge education for parents of young children. Further insights will come from closer attention to the nature and role of restrictive feeding practices v. laxness and longitudinal research.

Observed assertive and intrusive maternal feeding behaviors increase child adiposity

BACKGROUND

Few studies have examined observed maternal feeding behaviors and their potential association with child adiposity. The association between maternal prompting to eat and child adiposity has been inconsistent.

OBJECTIVES

This study sought to identify factors associated with maternal feeding behaviors and to test the hypothesis that more maternal prompts to eat, more assertive prompts, and more intrusiveness are associated with greater child adiposity.

DESIGN

Children (n = 1218) and their mothers were videotaped eating a standardized snack at ages 15, 24, and 36 mo. Maternal prompts to eat, the percentage of prompts that were assertive, and intrusiveness were coded. Adjusted regression analyses evaluated predictors of prompts, the percentage of assertive prompts, and intrusiveness and the relation of each of these factors with child adiposity (weight-for-length z score at 15 mo and BMI z score at 24 and 36 mo) after control for the child's race-ethnicity and sex, family income-to-needs ratio, and maternal education, weight status, and depressive symptoms.

RESULTS

At 36 mo, mothers gave an average of 9.3 prompts; 61% of prompts were assertive, and 48% of mothers were intrusive. Lower maternal education and minority race-ethnicity were associated with a greater percentage of assertive prompts and intrusiveness. A greater percentage of assertive prompts and intrusiveness, but not total prompts, was associated with higher child adiposity.

CONCLUSIONS

Assertive prompting and an intrusive style had small but significant associations with greater child adiposity. Future work should focus on maternal motivations for assertive and intrusive feeding styles and mechanisms through which these feeding styles might increase child adiposity.

A twin study of self-regulatory eating in early childhood: estimates of genetic and environmental influence, and measurement considerations

OBJECTIVE

Children differ greatly in their ability to self-regulate food intake for reasons that are poorly understood. This laboratory-based twin study tested the genetic and environmental contributions to self-regulatory eating and body fat in early childhood.

METHODS

A total of 69 4-7 year-old same-sex twin pairs, including 40 monozygotic and 29 dizygotic pairs, were studied. Self-regulatory eating was operationalized as the percentage compensation index (COMPX%), assessed by a 'preload' challenge in which lunch intake was measured following a low- (3 kcal) or high-calorie (159 kcal) drink. Body fat indexes also were measured. The familial association for COMPX% was estimated by an intraclass correlation, and biometric analyses estimated heritability.

RESULTS

Children ate more at lunch following the low- compared with high-energy preload (P<0.001), although variability in COMPX% was considerable. Compensation was significantly poorer among African American and Hispanic compared with European American children, and among girls compared with boys. There was a familial association for self-regulatory eating (ρ = 0.23, P = 0.03) but no significant genetic component. In all, 22% of the variance in COMPX% was due to shared environmental 'household' factors, with the remaining variance attributable to child-specific 'unique' or 'random' environments. Poorer self-regulatory eating was associated with greater percent body fat (r = -0.21, P = 0.04).

CONCLUSIONS

Self-regulatory eating was influenced by environmental factors, especially those differing among siblings. The absence of a significant genetic effect may reflect the age of the sample or could be artifactual due to measurement issues that need to be considered in future studies.

Does child weight influence how mothers report their feeding practices?

OBJECTIVES

The present study aimed to ascertain whether parental reports of their feeding practices are associated with independent observations of these behaviours, and whether the reliability of maternal report depends upon the child's weight.

METHODS

A total of 56 mothers and their children ate a lunch to satiety which was videotaped and coded for maternal use of control during feeding. Mothers also completed questionnaires about their feeding practices and children were weighed and measured.

RESULTS

Maternal reports of controlling feeding practices were poorly related to independent observations of these behaviours in the laboratory. However, there was a significant interaction between child BMI z score and observed pressure to eat in predicting maternally reported pressure to eat. There was also a significant interaction between child BMI z score and observed maternal restriction with food in predicting maternally reported restriction. When decomposed, these interactions suggested that only mothers of relatively underweight children were accurate at reporting their use of pressure to eat when compared to independent observations. For mothers of relatively overweight children there was a significant negative relationship between observed and reported restriction over food.

CONCLUSIONS

Overall there was poor correspondence between maternal reports and independent observations of the use of controlling feeding practices. Further research is needed to replicate these findings and to ascertain whether parents who are inaccurate at reporting their use of these feeding practices are unaware that they are using controlling feeding practices or whether they are responding in socially desirable ways to questionnaires assessing their feeding behaviour.

The role of child temperament in parental child feeding practices and attitudes using a sibling design

Although previous research indicates that parental child feeding practices are one component of a bidirectional relationship between children and parents, little is known about how child temperament operates in this relationship. The purpose of this study was to investigate relationships between child temperament and parental feeding practices and attitudes using a sibling design. By collecting data regarding pairs of siblings, we were able to investigate sibling differences and differential parental treatment. We examined mothers' and fathers' perceptions of their two children's temperaments as well as reports of the feeding practices and attitudes they use with each child. Fifty-five mothers and fathers completed questionnaires including the Carey Temperament Scales and the Child Feeding Questionnaire (CFQ). Results from correlation analyses showed that 6 of the 9 father reports of temperament between two siblings were positively related, whereas 1 of the 9 mother reports were positively related. Mothers' and fathers' perceptions of temperament were positively correlated for a single child. Some patterns were found between parental reports of sibling temperament and child feeding practices and attitudes, suggesting that temperament plays a role in how parents feed their children.

Association between parenting practices and children's dietary intake, activity behavior and development of body mass index: the KOALA Birth Cohort Study

Background

Insights into the effects of energy balance-related parenting practices on children's diet and activity behavior at an early age is warranted to determine which practices should be recommended and to whom. The purpose of this study was to examine child and parent background correlates of energy balance-related parenting practices at age 5, as well as the associations of these practices with children's diet, activity behavior, and body mass index (BMI) development.

Methods

Questionnaire data originated from the KOALA Birth Cohort Study for ages 5 (N = 2026) and 7 (N = 1819). Linear regression analyses were used to examine the association of child and parent background characteristics with parenting practices (i.e., diet- and activity-related restriction, monitoring and stimulation), and to examine the associations between these parenting practices and children's diet (in terms of energy intake, dietary fiber intake, and added sugar intake) and activity behavior (i.e., physical activity and sedentary time) at age 5, as well as BMI development from age 5 to age 7. Moderation analyses were used to examine whether the associations between the parenting practices and child behavior depended on child characteristics.

Results

Several child and parent background characteristics were associated with the parenting practices. Dietary monitoring, stimulation of healthy intake and stimulation of physical activity were associated with desirable energy balance-related behaviors (i.e., dietary intake and/or activity behavior) and desirable BMI development, whereas restriction of sedentary time showed associations with undesirable behaviors and BMI development. Child eating style and weight status, but not child gender or activity style, moderated the associations between parenting practices and behavior. Dietary restriction and monitoring showed weaker, or even undesirable associations for children with a deviant eating style, whereas these practices showed associations with desirable behavior for normal eaters. By contrast, stimulation to eat healthy worked particularly well for children with a deviant eating style or a high BMI.

Conclusion

Although most energy balance-related parenting practices were associated with desirable behaviors, some practices showed associations with undesirable child behavior and weight outcomes. Only parental stimulation showed desirable associations with regard to both diet and activity behavior. The interaction between parenting and child characteristics in the association with behavior calls for parenting that is tailored to the individual child.

A systematic review of responsive feeding and child obesity in high-income countries

Child overweight/obesity continues to be a serious public health problem in high-income countries. The current review had 3 goals: 1) to summarize the associations between responsive feeding and child weight status in high-income countries; 2) to describe existing responsive feeding measures; and 3) to generate suggestions for future research. Articles were obtained from PubMed and PsycInfo using specified search criteria. The majority (24/31) of articles reported significant associations between nonresponsive feeding and child weight-for-height Z-score, BMI Z-score, overweight/obesity, or adiposity. Most studies identified were conducted exclusively in the United States (n = 22), were cross-sectional (n = 25), and used self-report feeding questionnaires (n = 28). A recent trend exists toward conducting research among younger children (i.e. infants and toddlers) and low-income and/or minority populations. Although current evidence suggests that nonresponsive feeding is associated with child BMI or overweight/obesity, more research is needed to understand causality, the reliability and validity between and within existing feeding measures, and to test the efficacy of responsive feeding interventions in the prevention and treatment of child overweight/obesity in high-income countries.

Parental feeding and childhood obesity in preschool-age children: recent findings from the literature

BACKGROUND

Research from recent studies (2005-2010) concerning parent feeding of preschool children and the risk for childhood obesity were included in this review.

METHODS

An integrative literature review method, as proposed by Whittemore and Knalf (2005) , was used to analyze data from a broad array of research methods, such as qualitative and experimental, and represent research from multiple disciplines. Rigor was maintained by using clearly defined variables, maintaining an audit trail, and opening the research for review from peers and experts. Eighteen peer reviewed journal articles (3 qualitative and 15 descriptive, cross-sectional studies) were included.

RESULTS

Findings from these articles contribute to a better understanding of factors related to feeding and parents from different cultural, educational and economic backgrounds, and their children's risk for obesity. Specifically, findings concerned how parents controlled and modified their children's eating, parental perception of their children's risk for obesity, what influenced parental feeding practices and how mothers' disinhibited eating and restrictive parenting practices related to their children's risk for obesity.

CONCLUSIONS

These findings may impact the efficacy of childhood obesity prevention and intervention efforts and direct future childhood obesity research.