Parental Restrictive Feeding Research Articles

Positive Feeding Practices During Childhood Are Associated With Higher Intuitive Eating in Adulthood

ABSTRACT Background Parental restrictive feeding and pressure to eat have been negatively associated with intuitive eating. However, parental feeding practices that promote intuitive eating are less understood. Purpose To examine caregiver feeding practices that may promote intuitive eating and the moderating effect of gender. Method A cross-sectional survey with 941 U.S. adults who completed the Intuitive Eating Scale-2 and recalled their primary childhood caregiver(s)’ feeding practices. Results Ensuring the availability of healthful foods at home was associated with higher intuitive eating among both female (b = 0.147, P < .001) and male (b = 0.091, P = .018) participants. Encouraging diet diversity (b = 0.095, P = .009) was associated with higher intuitive eating among female participants only, whereas honoring children’s hunger and satiety feelings (b = 0.136, P = .001) was associated with higher intuitive eating among male participants only (adjusted for participants’ current age, education, and income). Discussion Findings established links between positive caregiver feeding practices and higher intuitive eating, with gender playing a moderating role. Translation to Health Education Practice The design and results of the study relate to the National Commission for Health Education Credentialing Inc. responsibilities, competencies, and subcompetencies (areas I, II, IV, and V). A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars

Food texture preferences in early childhood: Insights from 3–6 years old children and parents

Rejection of specific food textures in young children can be a significant barrier to establishing healthy eating habits. However, the literature on texture preferences in children under seven is sparse, partially due to a lack of suitable test tools for this age range. This study aims to investigate texture preferences in 3 to 6-year-old children and their parents and identify factors that could influence children’s preferences. Children (n = 235) completed a forced-choice questionnaire based on pictographic drawings of 14 pairs of foods differing in hardness (hard versus soft) or particle content (with-particle versus no-particle). Parents completed the same questionnaire and provided information on their feeding practices and children’s eating behaviors. To assess the questionnaire’s validity, children performed a paired preference test using actual food stimuli corresponding to 6 food pairs in the questionnaire. Results showed that children preferred foods without particles, and such preference was associated with food neophobia. Children did not show distinct preferences for foods differing in hardness, but older children preferred soft foods more than younger children. Texture preferences significantly differed between parents and children, with a low concordance between parent–child dyads (49–55 %). Parental restrictive feeding was associated with children’s rejection of particles in foods, whereas children’s experience with different textures was associated with preferences for foods containing particles. Moreover, the questionnaire showed agreement with children’s preferences measured using actual foods, and the validity increased with age. This study demonstrated that young children’s texture preferences follow developmental trends and depend on the eating environment.

Bidirectional Associations between Parental Non-Responsive Feeding Practices and Child Eating Behaviors: A Systematic Review and Meta-Analysis of Longitudinal Prospective Studies.

Background: Parental non-responsive feeding practices and child eating behaviors both play significant roles in childhood obesity. However, their longitudinal relationships are less clear. This systematic review aimed to examine their bidirectional associations. Methods: A systematic search of five databases was conducted from inception to February 2022. Data synthesis was performed using a semi-quantitative and quantitative approach. Results: A total of 14 studies with 15348 respondents were included. A total of 94 longitudinal effects from 14 studies of parental non-responsive feeding practices on child eating behaviors were investigated, and 19 statistically significant effects were discovered. Seventy-seven longitudinal effects from nine studies of child eating behaviors on parental feeding practices were examined, with fifteen being statistically significant. The pooled results of meta-analysis showed five statistically significant associations: parental restrictive feeding positively predicted child enjoyment of food (β = 0.044; 95% CI: 0.004, 0.085); use of food as a reward positively predicted child emotional eating (β = 0.09; 95% CI: 0.04, 0.15); child food responsiveness positively predicted restrictive feeding (β = 0.04; 95% CI: 0.02, 0.06); use food as a reward (β = 0.06; 95% CI: 0.03, 0.10). In addition, the pooled effects showed that child satiety responsiveness negatively predicted restrictive feeding (β = −0.05; 95% CI: −0.08, −0.01). Conclusions: The bidirectional relationships between parental non-responsive feeding practices and child eating behaviors are inconsistent and a few showed statistical significance. Theory-driven longitudinal studies using validated instruments and controlling for potential confounders are needed to unveil their relationships and provide evidence for obesity prevention interventions.

Changes in Child Weight, Behaviors, and Family Dynamics during Parental Participation in a Medical Weight Management Program: A Longitudinal Uncontrolled Pilot Study.

Background: There is limited evidence of the effects of parental participation in outpatient medical weight management (MWM) programs on children. The aims of the project were to (1) identify time effects from parental participation in the MWM program on changes in child weight trajectories, healthy and unhealthy weight control practices, physical and sedentary activity, parental restrictive feeding and pressure to eat, and family functioning and communication and (2) determine differences based on child factors. Methods: A longitudinal uncontrolled pilot study was conducted, in which parent-child (ages 7-19) dyads completed assessments at parents' MWM program initiation, 3 months (mid-program), 6 months (end of program), and 12 months to determine sustained effects. Repeated measures analysis of variance (ANOVA) was completed using a mixed multilevel modeling approach using Restricted Maximum Likelihood estimation method; each outcome was additionally analyzed with child baseline weight status, age group, and sex as between-subjects factors. Results: Fifty three dyads met inclusion criteria, 23 completed the initial assessment (enrollment: 43.3%), and 13 completed the 12-month assessment (retention: 56.5%). Significant effects over time were observed for decreased parental restrictive feeding (p < 0.038) over 12 months, and group by time effects were observed for increased restrictive feeding for female compared to male children (p = 0.025) over 12 months. Marginally significant group by time effects were found for increased impaired family functioning (p = 0.054) and communication (p = 0.054) for children with overweight/obesity compared to healthy weight children over 12 months. Conclusions: Female children and children with overweight/obesity may experience increased negative family dynamics (restriction of food, family functioning, and communication) through parental MWM programs.

Exploring the association between parental anti-fat attitudes and restrictive feeding practices in a British and Irish sample

Parental restriction of food intake has been associated with heightened eating disorder psychopathology in some longitudinal research. Yet, relatively little is known about the determinants of restrictive feeding practices. This cross-sectional study explored the association between parents' anti-fat attitudes and their use of restrictive feeding practices in a mixed British (41.10% England, 39.90% Scotland, 4.20% Other) and Irish (14.80%) sample. Parents and caregivers (N = 472; 94.10% female; 70.90% university level education) of children between the ages of 4–8 (48.20% female; 91.10% rated as “normal weight” by their parents) completed self-report questionnaires assessing their anti-fat attitudes (dislike, fear, and blame subscales), use of restrictive feeding practices (for weight control, health purposes, and covert restriction), and how influential their child's body-weight and -shape is for their perception of themselves as parents. Overall, our hypothesis that parental anti-fat attitudes would be significantly associated with restrictive feeding practices was supported. Anti-fat attitudes related to disliking higher body-weight people and blaming parents for their child's weight were significant predictors of all forms of restrictive feeding (all ps < .05). However, anti-fat attitudes related to fearing being a higher body-weight were not significant predictors of restrictive feeding for the purposes of health nor for covert restriction (ps > .05). Additionally, our hypothesis that the associations between anti-fat attitudes and restrictive feeding practices would be stronger for parents for whom their child's body-weight and -shape more strongly influenced how they judged themselves as parents was not supported (the interaction term was not significant in two out of three analyses). Future research is needed to investigate these associations across time and in samples of higher body-weight children.

Associations of Early Parental Concerns and Feeding Behaviors with Child's Diet Quality through Mid-Childhood.

Parental feeding practices have been associated with children’s dietary intakes, yet the directionality of these associations remains unclear. Among 1172 mother-child pairs from Project Viva, we aimed to examine associations of parental concerns and feeding behaviors at 2 years (behaviors dichotomized as yes vs. no), with diet quality (Youth Healthy Eating Index; YHEI) in early (mean 3.2, SD 0.3 years; n = 1076) and mid-childhood (mean 7.8, SD 0.7 years; n = 993). We used multivariable linear regression models adjusted for sociodemographic characteristics, parental body mass index (BMI), maternal diet quality in pregnancy, and child’s BMI z-score and diet quality at 2 years. Early parental concerns about their child becoming overweight (15%) was associated with lower YHEI (β −1.54 points; 95%CI −2.75, −0.33; fully adjusted model) in early childhood. Early parental concerns about their child becoming underweight (7%) was associated with lower YHEI (−2.19 points; −4.31, −0.07) in early childhood, but the association was attenuated after adjustment for child’s BMI z-score and diet quality at 2 years. We did not find associations of parental restrictive feeding (8%) and parental pressure to eat (47%) with child’s YHEI through mid-childhood. In conclusion, we found no evidence that early parental concerns and feeding behaviors independently contribute to child’s diet quality through childhood.

Abstract P289: Parenting Practices are Associated With Body Mass Index and Blood Pressure Among Latinx Adolescents

Introduction: Adherence to dietary recommendations among Latinx adolescents is low, contributing to an increased risk for obesity and cardiometabolic disease. Parents play a crucial role in adolescents’ disease risk and diet quality due to their role in modeling healthful behaviors and providing food. However, information about how parental monitoring and eating-related parenting practices are associated to cardiovascular risk is scarce. Hypothesis: We hypothesized that unhealthful parenting practices would be associated with higher cardiometabolic risk factors among Latinx adolescents. Methods: We included 61 parent-adolescent (6 th -8 th grade) Latinx dyads. Parents self-reported information about parental monitoring, family eating habits (use of media during meals, inclusion of specific foods during dinner, fast food intake), parental feeding style, and parental energy index (whether parents have had conversations with their children regarding weight and healthful diet and physical activity behaviors). Adolescent cardiometabolic risk factors measured include blood pressure (BP), total cholesterol, and HbA1c. Age- and sex-adjusted BMI percentile (BMI%) and z-scores (BMIz) were calculated from weight and height measurements. Associations between parental practices and cardiometabolic risk factors were analyzed using linear regression (B) and correlation (r). Results: Adolescents’ measured risk factors were as follows: SBP=106±11 mm Hg, DBP=62±7 mm Hg, weight=61±15 kg, BMI%=83±20, BMIz=1.2±0.9, HbA1c=5.1±0.4 %, and total cholesterol=164±12 mg/dL. Use of media during meals (e.g., TV, electronic devices) was associated with higher adolescent weight (B=7.97; r=.31; p=.02) and BMIz (B=.37; r=.27, p=.05). Parental restrictive feeding style was associated with higher adolescent weight (B=5.54; r=.22; p=.03), BMI% (B=13.19; r=.52, p=.001) and diastolic BP (B=2.50; r=.27, p=.04). Adolescent children of parents reporting a greater parental energy index had a greater body weight (B=6.90; r=.46; p=.001) and BMI % (B=6.28; r=.33, p=.01). Parent-reported frequency of consuming family meals, frequency of fast food meals, importance of consuming family meals, and inclusion of vegetables, fruit and 100% juice, milk, and sugar-sweetened beverages during family meals were not associated with adolescents’ BMI or BP. Associations with other risk factors were not significant. Conclusions: Results suggest that unhealthful parenting practices such as restrictive feeding and allowing the use of media during meals may negatively influence cardiometabolic risk factors among Latinx adolescents. Parents of children with a greater BMI reported having more conversations about weight and healthful behaviors with their children. Future family-based behavioral interventions for this population should incorporate more parenting strategies as part of their curricula.

Parental restrictive feeding with Latinx adolescents: Examining the role of adolescent effortful control

The objective of this study was to test if youth effortful control, a general process of self-regulation that is rooted in temperament, uniquely predicts maternal restrictive feeding with Latinx adolescents above and beyond demographic/contextual factors, prior use of restrictive feeding, and common markers of obesity-proneness. The study sample consisted of Latinx fifth and sixth graders and their mothers residing in the Midwestern U.S. (N = 97 dyads). Effortful control, maternal restrictive feeding, demographic/contextual factors, and markers of obesity proneness were measured across two waves of data collection approximately one year apart. Results demonstrated an inverse relation between effortful control and maternal restrictive feeding after controlling for Time 1 demographic/contextual factors, maternal BMI, maternal restrictive feeding, youth BMI z-score, and perceived youth weight. Future directions include testing for the presence of an ironic feedback process such that Latinx mothers' attempts to overcome deficits in their children's self-regulation skills through restrictive feeding may be inadvertently maintaining the problem.

Pumpkin is “yucky”!: A prospective study of overt and covert restriction in the development of young children's food preferences

The aim of the study was to investigate maternal feeding strategies as prospective predictors of young children's food preferences. Participants were 106 mother – child dyads with data collected when children were aged 4 (Time 1) and then again at 6 years old (Time 2). Mothers completed an initial questionnaire at Time 1 which contained measures of restrictive and covert feeding strategies. Children were interviewed concerning their food preferences and had their height and weight measured at Time 1 and again two years later (Time 2). Longitudinal regression results showed that Time 1 parental restrictive feeding predicted decreased child-reported preferences for fruit and vegetables and increased preferences for salty food and sweets at Time 2. Conversely, Time 1 parental covert control predicted greater child-reported preferences for fruit and vegetables over time. The results provide longitudinal evidence of the negative impact of restrictive feeding, and of the positive impact of covert control, on the development of young children's food preferences.

“That’s enough now!”: A prospective study of the effects of maternal control on children’s snack intake

The aim of this study was to investigate maternal feeding strategies as prospective predictors of young children’s snack intake. Participants were 252 mothers of children aged 3–11 years old who completed questionnaire measures of parent feeding strategies (Restriction and Covert Control) and reported on their child’s healthy and unhealthy snack intake at two time points separated by three years. Longitudinal regression models showed no prediction of healthy snack food intake. However, Time 1 parental restrictive feeding predicted greater unhealthy snack intake at Time 2, while Time 1 covert feeding strategies predicted lower unhealthy snack intake at Time 2. Structural equation modeling showed that these associations were independent of known covariates that influence children’s snack intake (child and parent weight, education level and SES). The results provide longitudinal evidence for the negative impact of restrictive parent feeding strategies on children’s snack intake and highlight the importance of dissuading parents from using this type of feeding control. Instead, parents should be encouraged to use more covert feeding strategies that are associated with less unhealthy snack intake over the longer term.

Testing the direction of effects between child body composition and restrictive feeding practices: results from a population-based cohort

Background: Parental restrictive feeding (i.e., limiting food intake of children) has been linked to childhood overweight. However, the directionality of the causal pathway remains unknown.Objective: The objectives of this study were to examine the bidirectional association of maternal restrictive feeding with children's weight and body composition across childhood and to explore a possible mediating role of maternal concern about child weight.Design: Data were available for 4689 mother-child dyads participating in Generation R, a prospective birth cohort in the Netherlands. At ages 4 and 10 y, restrictive feeding was assessed with the parent-reported Child Feeding Questionnaire, and children's body mass index (BMI) was measured. At age 6 y, fat mass index (FMI) and fat-free mass index (FFMI) were measured with dual-energy X-ray absorptiometry. Both directions of the relation between restriction and child body composition were examined with multivariable linear regression analyses and cross-lagged modeling. Mediation analyses were performed to examine concern about child weight (mother reported at child age of 10 y) as a potential mediator.Results: Higher child sex- and age-adjusted BMI SD scores (zBMI) at age 4 y predicted more restrictive feeding at age 10 y (B = 0.15; 95% CI: 0.11, 0.18). Both sex- and age-adjusted FMI SD scores (zFMI) and sex-and age-adjusted FFMI SD scores (zFFMI) at 6 y were also positively associated with restrictive feeding at 10 y. Maternal concern about child weight partially mediated these associations from child body composition to restrictive feeding (e.g., for zBMI at 4 y: Bindirect = 0.10; 95% CI: 0.07, 0.13). There was no temporal association from restrictive feeding at age 4 y to child zBMI at age 10 y after adjustment for baseline zBMI.Conclusions: The continued use of restrictive feeding practices at age 10 y appeared to be primarily a response of mothers to an unhealthy weight of their child rather than a cause of children's overweight. Guidelines discouraging restrictive feeding for preventing childhood overweight should therefore be reconsidered.

Relationship between Parental Feeding Practices and Neural Responses to Food Cues in Adolescents.

Social context, specifically within the family, influences adolescent eating behaviours and thus their health. Little is known about the specific mechanisms underlying the effects of parental feeding practices on eating. We explored relationships between parental feeding practices and adolescent eating habits and brain activity in response to viewing food images. Fifty- seven adolescents (15 with type 2 diabetes mellitus, 21 obese and 21 healthy weight controls) underwent fMRI scanning whilst viewing images of food or matched control images. Participants completed the Kids Child Feeding Questionnaire, the Childrens’ Dutch Eating Behaviour Questionnaire (DEBQ) and took part in an observed meal. Parents completed the Comprehensive Feeding Practices Questionniare and the DEBQ. We were particularly interested in brain activity in response to food cues that was modulated by different feeding and eating styles. Healthy-weight participants increased activation (compared to the other groups) to food in proportion to the level of parental restriction in visual areas of the brain such as right lateral occipital cortex (LOC), right temporal occipital cortex, left occipital fusiform gyrus, left lateral and superior LOC. Adolescents with type 2 diabetes mellitus had higher activation (compared to the other groups) with increased parental restrictive feeding in areas relating to emotional control, attention and decision-making, such as posterior cingulate, precuneus, frontal operculum and right middle frontal gyrus. Participants with type 2 diabetes mellitus also showed higher activation (compared to the other groups) in the left anterior intraparietal sulcus and angular gyrus when they also reported higher self restraint. Parental restriction did not modulate food responses in obese participants, but there was increased activity in visual (visual cortex, left LOC, left occipital fusiform gyrus) and reward related brain areas (thalamus and parietal operculum) in response to parental teaching and modelling of behaviour. Parental restrictive feeding and parental teaching and modelling affected neural responses to food cues in different ways, depending on motivations and diagnoses, illustrating a social influence on neural responses to food cues.

Parent binge eating and restrictive feeding practices: Indirect effects of parent's responses to child's negative emotion

ObjectiveParents' emotion regulation difficulties are related to binge eating (BE), and to responses to children's negative emotion. However, less is known about how responses to children's negative emotion are related to eating and feeding in the parenting context. We examined the degree to which BE had both direct and indirect effects on parental restrictive feeding practices, through parents' reported responses to negative emotion. MethodParents of preschoolers (n=441) completed validated questionnaires about their feeding strategies, responses to children's negative emotion, and their children's eating behaviors. Height and weight were measured in children and self-reported by parents. Unsupportive (Distress, Minimizing, and Punitive), and Supportive (Emotion-focused, Problem-focused, and Expressive Encouragement) responses to negative emotion were measured using the Coping with Children's Negative Emotions Scale. ResultsParent's BE was correlated with Distress responses, Restriction for health, and Restriction for weight control. Controlling for confounders, BE was associated with Restriction for weight control, and Restriction for health. Model testing revealed that BE had significant direct (R2 [SE]=.073 [.031], 95% CI [.013, .134]) and indirect effects (R2 [SE]=.011 [.005], 95% CI [.003, .023]) on Restriction for weight control, through Distress responses, but only indirect effects on Restriction for health (R2 [SE]=.018 [.009], 95% CI [.004, .039]). ConclusionsThis study shows an association between emotion regulation and energy-intake regulation in the parenting context. Efforts to modify feeding practices may be more effective if parents' eating behaviors and their emotional responsiveness to distress are taken into account.

Estimating controlled direct effects of restrictivefeeding practices in the 'Early dieting in girls' study.

In this article, we examine the causal effect of parental restrictive feeding practices on children's weight status. An important mediator is children's self-regulation status. Recent approaches interpret mediation effects based on the potential outcomes framework. Inverse probability weighting based on propensity scores are used to adjust for confounding and reduce the dimensionality of confounders simultaneously. We show that combining machine learning algorithms and logistic regression to estimate the propensity scores can be more accurate and efficient in estimating the controlled direct effects than using logistic regression alone. A data application shows that the causal effect of mother's restrictive feeding differs according to whether the daughter eats in the absence of hunger.

Risk Factors for Overweight/Obesity in Preschool Children: An Ecological Approach

Identification of risk factors is critical to preventing the childhood obesity epidemic. Risk factors that contribute to obesity are multifactorial. However, limited research has focused on identifying obesity risk factors using an ecological approach. Baseline self-report survey data from the STRONG Kids program were used. The sample consisted of 329 parent-child dyads recruited from childcare programs in east-central Illinois. Child height and weight were measured and converted to age- and sex-specific z-scores using standard growth charts. An ecological model provided the theoretical framework for the selection of 22 previously reported childhood obesity risk factors. Multiple logistic regression analyses were used to identify risk factors. Of 22 potential risk factors, three were found to be significantly associated with child overweight/obesity. These included child nighttime sleep duration (χ(2)=8.56; p=0.003), parent BMI (χ(2)=5.62; p=0.01), and parental restrictive feeding for weight control (χ(2)=4.77; p=0.02). Children who slept for 8 hours and less were 2.2 times more likely to be overweight/obese [95% confidence interval (CI): 1.3-3.7), whereas children with an overweight/obese parent were 1.9 times more likely to be overweight/obese (95% CI: 1.12-3.2). Finally, children whose parents used restrictive feeding practices were 1.75 times more likely to be overweight/obese (95% CI: 1.06-2.9). Using an ecological approach, we conclude that childhood obesity prevention efforts may benefit from targeting the key risk factors of child sleep duration, parent BMI, and parental restrictive feeding practices as focus areas for obesity prevention.