Adjusting to motherhood. The importance of BMI in predicting maternal well-being, eating behaviour and feeding practice within a cross cultural setting

The trajectory of body image dissatisfaction during pregnancy and postpartum and its relationship to Body-Mass-Index

BACKGROUND

During pregnancy, women's bodies undergo rapid body weight and size changes within a relatively short period. Pregnancy may therefore, be associated with an increased vulnerability for developing body image dissatisfaction linked to adverse health outcomes for the mother (e.g., depression, eating disorders) and child (e.g., impaired self-regulation, childhood obesity). The present study aims to examine the prevalence and trajectories of body image dissatisfaction during pregnancy and postpartum and its relationship to pre-pregnancy BMI. This is the first study that investigates prevalence rates of body image dissatisfaction not only ante- but also postpartum, and that compares trajectories of women with normal weight and overweight.

METHODS

A prospective longitudinal design with a quantitative approach was applied. Healthy pregnant women (N = 136) answered paper-pencil or online questionnaires at four time points (18th-22nd and 33rd-37th week of gestation, 3 and 6 months postpartum). Body image dissatisfaction was assessed using the German version of the Body Shape Questionnaire (BSQ) and the Eating Disorder Examination Questionnaire (EDE-Q). Both questionnaires are considered reliable and valid measures of several aspects of body image, and the BSQ allows for calculating prevalence rates by providing cut-off values. Using not just one but two body image questionnaires, trajectories of body image dissatisfaction can be compared. Pre-pregnancy BMI was assessed retrospectively via self-reported weight and height.

RESULTS

The proportion of women reporting elevated levels of body image dissatisfaction was 6.6% (n = 9) in the second trimester, 2.9% (n = 4) in the third trimester, 11.0% (n = 15) three months postpartum, and 10.3% (n = 14) six months postpartum. Repeated measures ANOVA revealed that body image dissatisfaction significantly decreased from pre-pregnancy to pregnancy, remained stable during pregnancy, and returned to pre-pregnancy levels three to six months postpartum. Mixed between-within ANOVA showed that the overweight/obese group reported significantly higher levels of body image dissatisfaction at each measurement point except during the third trimester than women in the normal weight group. Significant but small interaction effects between time and pre-pregnancy BMI were found.

CONCLUSIONS

The results revealed that approximately every tenth woman is affected by body image dissatisfaction after childbirth. Women with a higher BMI level before pregnancy are particularly at risk of experiencing body image dissatisfaction. Healthcare providers should screen for body image dissatisfaction, in particular after childbirth, and inform affected women about possible adverse health outcomes and treatment options. Study limitations concern the drop-out rate of 51.4% and the retrospective and self-reported assessment of pre-pregnancy BMI. Future studies should include additional assessment points in the first trimester and more than six months postpartum and try to include a matched control group of non-pregnant women to compare prevalence rates and trajectory of body image dissatisfaction.

Comparing body image dissatisfaction between pregnant women and non-pregnant women: a systematic review and meta-analysis

Body image dissatisfaction refers to negative thoughts and feelings individuals have towards their own body appearance and this is thought to be affected by the physiological changes that occur during pregnancy. There are two main conflicting theories as to the effect pregnancy has on body image dissatisfaction: 1) Pregnancy related changes are in direct conflict with social ideas of female beauty (e.g. weight gain) and so increase body image dissatisfaction; 2) Due to changes in expectations of bodily appearance during pregnancy, women are liberated from social ideals at this time and thus body image dissatisfaction would decrease. This study aimed to assess these theories by synthesising the current literature. Six databases were searched, and 2,017 study abstracts were screened based on strict inclusion and exclusion criteria. Following screening and quality assessment by two blind reviewers, 17 studies (comprising 17 effect sizes) were subject to full review and meta-analysis following PRISMA guidelines. These studies included cross-sectional, longitudinal and retrospective designs. Results varied with some studies showing women to feel more positive about their body during pregnancy, others showing a more negative body experience and yet others showing no statistical difference. Overall the analysis showed no statistical difference in body image dissatisfaction between pregnant women and non-pregnant women (p = 0.39). Any changes that do occur are heterogeneous and likely to be largely dependent on the individual experience as well as moderator variables and other factors such as differences in methodology of research studies. Studies in this field of research would benefit from more explicit and complete reporting of data and key variables, in order to allow early intervention for women who display body image dissatisfaction in pregnancy.

Comparison of mothers' perceptions of hunger cues in 3-month-old infant under different feeding methods

BACKGROUND

Mothers' perception of infant hunger cues is a critical content of responsive feeding, which is central to the promotion of early childhood development. However, only a few studies have examined responsive feeding in China, especially lacking the studies on perceptions of infant hunger cues. Consider the cultural differences, the aim of this study was to describe the perceptions of infant hunger cues of Chinese mothers for infants aged 3 months, and explore the relationship between maternal perceptions of infant hunger cues and different feeding methods.

METHODS

A cross-sectional study was conducted with a sample of 326 mothers of healthy 3-month-old infants, including 188 exclusive breastfeeding (EBF) mothers and 138 formula feeding (FF) mothers. It was implemented in four provincial and municipal maternal and child health hospitals. The mothers' perceptions of infant hunger cues were surveyed by self-reporting questionnaires. Chi-square tests and logistic analysis were applied to analyze the differences in maternal perceptions of infant hunger cues, including the number of hunger cues and the specific cues, between EBF group and FF group by controlling sociodemographic variables and the daily nursing indicators.

RESULTS

We found that a higher proportion of EBF mothers could perceive multiple hunger cues (≥ 2) than FF mothers (66.5% vs.55.1%). For specific cues, the EBF mothers had higher perceptions of infant's "hand sucking" (67.6% vs. 53.6%) and "moving head frantically from side to side" (34.6% vs. 23.9%), all p < 0.05. Regression analysis revealed that EBF might support mothers to perceive infant hunger cues than FF mothers, with the number of infant hunger cues (OR = 1.70, 95% CI: 1.01-2.85), "hand sucking" (OR = 1.72, 95% CI: 1.04-2.87), "moving head frantically from side to side" (OR = 2.07, 95% CI: 1.19-3.62). The number of infant hunger cues perceived by mothers was also associated with their educational level and family structure.

CONCLUSION

EBF mothers of 3-month-old infants may be more likely to perceive infant hunger cues than FF mothers in China. It is necessary to increase the health education about infant hunger and satiety cues to caregivers in China, especially among mothers with lower education levels, mothers living in nuclear families, and FF mothers.

Well-being, self-esteem and body satisfaction in new mothers

BACKGROUND

How mother's recall their experience of childbirth, their concerns about body image, their sense of competence in parenting, and their combined sense of self-esteem are all factors with the potential to impact on mental well-being.

METHOD

A total of 234 women, who had given birth within the past 3 years, completed a survey comprised of the Birth Memories and Recall Questionnaire, the Parenting Sense of Competence Scale, the Warwick-Edinburgh Mental Well-being Scale, the Rosenberg Self-Esteem Questionnaire and the Body Shape Questionnaire.

RESULTS

Mothers who have higher body dissatisfaction show significantly lower well-being, self-esteem and perceived parenting competence. Mothers who experienced higher levels of mental well-being were found to have higher levels of perceived parenting competence and self-esteem, and those who experienced higher levels of self-esteem were also found to have higher levels of perceived parenting competence.

CONCLUSION

Memories of the birth experience, perceived postpartum body image, parenting sense of competence and self-esteem have a combined and complex relationship with mental well-being. Health care professionals should inform mothers about the body changes which may occur throughout the postpartum period, to encourage mothers not to be deceived by media images and to stress the importance of realistic expectations following giving birth.

Body dissatisfaction of women during postpartum period and copin strategies

This descriptive, cross-sectional study examined body dissatisfaction and coping strategies of postpartum women. Women (n = 256) registered at a family health center in Turkey responded to a Participant Information Form and the Body Cathexis Scale between September 1 and December 31, 2020. The data were evaluated using the analyses of percentage, number, mean, standard deviation, Kruskal Wallis test, Mann Whitney U, Pearson correlation analysis, and Bonferroni tests. Women's dissatisfaction related to body image perception were associated with loss of physical strength, weight gain, hair loss, insomnia, change of breast shape, waist/back pain, facial spots, shape change in genitals, decrease in sexual activity and sexual desire, cellulite in the legs, and constipation. Regarding coping strategies, 8.4% women rested during the day to cope with the decrease in physical strength/fatigue they experienced, 44.5% followed a diet to cope with weight gain, 14% used shampoos and creams to cope with hair loss, 25.2% rested during the day to cope with insomnia, 36.8% wore a compression bra for their breasts, 12.4% exercised for waist/back pain. Findings indicate that postpartum women's average Body Cathexis Scale total score was low and that they experienced several issues regarding body image perception during this period.

Nurses' and midwives' perspectives on how the pursuit for the 'perfect' body image affects their own breastfeeding practices: a qualitative study in Ghana

Background

Body image concerns have been widely documented in the literature as one reason why most women shorten the breastfeeding duration of their infants. Negative body image concerns among breastfeeding mothers may lead to depressive symptoms. There is a paucity of literature on how body image affects the breastfeeding practices of nurses and midwives. Therefore, this study explored the perspectives of breastfeeding nurses and midwives on how their body image affected their breastfeeding practices.

Methods

A qualitative design was used in this study. Five focus group discussions were conducted with each group having five members. The study was conducted in the Greater Accra Region of Ghana between November and December of 2020. Participants were recruited into the study using a purposive sampling method. Focus group sessions were audiotaped and transcribed verbatim. Data were analyzed using a content analysis.

Results

Three main themes emerged from the data analysis: body image concerns and breastfeeding, sociocultural pressures and breastfeeding and coping strategies. Participants had concerns regarding weight gain due to the need to eat adequately while breastfeeding. Body image concerns included increase in abdominal size, sagging breasts and generalized weight gain. These concerns and pressures negatively affected the breastfeeding practices of participants. Body image concerns reflected sociocultural pressures such as negative comments from loved ones and in the social media. The coping strategies adopted by the mothers were self-motivation and the love they had for their children.

Conclusions

The perspectives of breastfeeding nurses and midwives on the ways their body image affected their breastfeeding practices identified the need for support in order to successfully breastfeed.

The Body Confident Mums challenge: a feasibility trial and qualitative evaluation of a body acceptance program delivered to mothers using Facebook

Background

Motherhood is a time of intense physical, psychological, and identity transformation, and body dissatisfaction may emerge through the process of pregnancy, birth, and adaptation to parenting. We present a feasibility trial of the Body Confident Mums Challenge, a program developed by adapting existing, effective interventions that focus on self-compassion and appreciation of body functionality to be specific to mothers.

Methods

The program was delivered using the social learning function in a closed Facebook group. Qualitative evaluation of evidence of change was conducted by gathering individual written reflections posted during the challenge (n = 120). Feasibility and acceptability was determined using a feedback survey (n = 22).

Results

Participant’s reflective posts indicated that they were embracing self-compassion, and de-prioritising body image concerns during the challenge. Feedback indicated that the program was mostly feasible and acceptable for mothers, with recommendations from some participants relating to slowing the pace of content delivery and reducing the time commitment of the Challenge.

Conclusions

The social media environment may therefore be a useful setting in which to implement brief intervention programs to improve body image and wellbeing.

Predictors of mothers' postpartum body dissatisfaction based on demographic and fertility factors

Background

There are fundamental and rapid changes in body shape during pregnancy, some of which persist for an extended time after delivery and may cause dissatisfaction with body shape. Therefore, we conducted this study to determine predictors of body dissatisfaction at six months postpartum based on demographic and fertility factors.

Methods

This cross-sectional study was conducted on 300 women who referred to seven health centers affiliated with Iran University of Medical Sciences, Tehran, Iran. The sampling was multistage and we collected data from a demographic and fertility questionnaire and Cooper’s Body Shape Questionnaire (BSQ-34). The independent t-test, Mann-Whitney U test, chi-square test, one-way ANOVA, Kruskal-Wallis, Pearson correlation coefficient, and multiple linear regression were used for data analysis. The level of significance was set at P < 0.05.

Results

The mean age of participating women was 29.77 (standard deviation: 5.9) years. Body dissatisfaction had a statistically significant association with variables such as body mass index (BMI) at six months postpartum, gestational age, the receipt of information about body shape, spouse’s views on the shape of a woman’s body, and mode of delivery. These variables predicted 34% of body dissatisfaction based on multiple linear regression.

Conclusion

Postpartum body dissatisfaction is related to a several variables. Paying attention to these variables will help to plan and improve postpartum counseling and educational programs.

Body Acceptance by Pregnant Women and Their Attitudes toward Pregnancy and Maternity as Predictors of Prenatal Depression

Background: Depressive symptoms during pregnancy may cause unfavorable consequences for both the mother and the infant's physiological and psychological health. Recent evidence indicates that body image plays an important role in prenatal depression. The present study's main purpose was to investigate the level of acceptance of physical appearance in pregnant women, their attitudes toward pregnancy and maternity, and some obstetric characteristics as significant predictors in the development of depression. Methods: A sample of 150 Polish pregnant women completed a set of self-report questionnaires, including the Edinburgh Postnatal Depression Scale (EPDS), Attitudes toward Maternity and Pregnancy Questionnaire (PRE-MAMA), and the Body-Self Questionnaire (EA-BSQ). All participants also answered a brief sociodemographic and obstetric information questionnaire. Results: A hierarchical binary logistic regression was conducted to predict prenatal depression from selected obstetric variables (unplanned pregnancy, multiparity, and miscarriages) and psychological variables (appearance evaluation and positive or anxious attitudes toward pregnancy and maternity). It was found that higher levels of negative evaluation of appearance increased chances of depression in pregnant women by almost one-and-a-half. The analysis revealed that positive attitudes toward pregnancy and maternity were the most important protective factor for depression. Conclusions: The results confirmed the importance of dissatisfaction with body image during pregnancy as a predictor of the onset of prenatal depression. However, in clinical practice, this risk factor should be considered in combination with positive maternal attitudes, not separately. The implications for future studies and interventions in the field of prenatal depression are discussed in this work.

The Eating Motivation Survey in Brazil: Results From a Sample of the General Adult Population

Brazil is undergoing a rapid nutrition transition with unfavorable effects on dietary healthiness. To counteract this trend, knowledge about individual drivers of consumption is needed that go beyond environmental factors. The Eating Motivation Survey represents a comprehensive measure of such individual drivers, assessing 15 eating motives, such as choosing food for health reasons or eating because of a good taste. The aim of this study was to examine the psychometric properties and validity of a Brazilian Portuguese version of The Eating Motivation Survey. In total, 442 participants from the general adult population living in the state of São Paulo, Brazil filled in an online survey. Results showed that the model, including 15 motive factors and 45 items, had a reasonable model fit. Moreover, factor loadings and corrected item-scale correlations were generally good. Fourteen out of the 15 motive scales had a reliability above 0.60. Results also confirmed convergent validity. These results demonstrate that the Brazilian Portuguese version of The Eating Motivation Survey is generally reliable and valid to assess individual drivers of eating behavior in Brazil.

Body experience and the mother-child relationship in pregnancy: a cross-sectional study of pregnant Portuguese women

Objective: In spite of the huge physical transformations that occur during pregnancy, there is little research on the role of body experience in the establishment of the mother-child relationship in pregnancy. The aim of the present study was to address this gap. Method: A sample of 330 pregnant women completed questionnaires assessing mother-child relationship (the Maternal-Fetal Attachment Scale), body experience, and other demographic and pregnancy variables. Results: Pearson's correlations revealed a number of variables were related to mother-child relationship in pregnancy, and t-tests and ANOVAs showed some between-subjects differences based on demographic variables. After controlling for these variables, regression analyses revealed that body experience was a significant predictor of both subscales of the Maternal-Fetal Attachment Scale: emotional investment in the baby and maternal role-taking. Conclusion: These findings highlight the connection between body experience and the psychological tasks of pregnancy and draw attention to new ways of assessing and improving mother-child relationships as early as in pregnancy. Results are discussed in terms of their clinical implications.

A systematic review examining the association between female body image and the intention, initiation and duration of post-partum infant feeding methods (breastfeeding vs bottle-feeding)

A systematic review was conducted to examine female body image in relation to the intention, initiation and duration of post-partum infant feeding methods. A search of 10 databases was conducted to identify studies. A total of nine studies were included in the systematic review. All studies were of a non-randomised control design with a total of 13,046 participants. Findings suggest that exclusive breastfeeding is more likely in pregnant women with a higher body image, while those with body concerns had less intention to breastfeed or initiate, with those who start having a shorter duration.

Mixed blessings: A qualitative exploration of mothers' experience of child care and feeding in the rapidly urbanizing city of Addis Ababa, Ethiopia

Many studies have drawn attention to the vital role mothers have in safeguarding the health and nutritional wellbeing of their children. However, little is known about mothers’ experiences and the challenges they face in fulfilling this role in rapidly urbanizing cities in Africa. This study aims to explore child care and feeding practices of mothers with children under five years of age in Addis Ababa, Ethiopia. This qualitative study was conducted using a semi-structured interview guide. A total of thirty-six interviews were conducted with purposively selected participants. All interviews were audio recorded, transcribed verbatim and translated for analysis. We used a thematic analysis approach, which was guided by a resilience framework. The findings are presented as three major themes. 1) ‘Mixed blessings-balancing motherhood’s expectations’. While mothers identified positively with the social recognition and sense of fulfillment of being a ‘good mother’, they were ambivalent/torn about earning the necessary income from outside work and fulfilling their duties at home. 2) ‘Instabilities due to rampant urban sprawl’. While women expressed a keen desire to balance work and motherhood, the disintegrating social capital, due to large in-migration, market fluctuations and abrupt/forced resettlements to new housing units had left mothers without support for childcare, stressed and exhausted. 3) ‘Anchored by faith: a source of resilience to cope with adversities’. In the face of the multiple adversities, mothers cited their strong faith as their most reliable foundation for their resilience. In summary, the societal and environmental changes accompanying the rapid urbanization in low income settings makes combining child care and working outside the home very challenging for mothers. As a result they suffer from fatigue and feelings of isolation. Efforts to improve child feeding and care in urban low-income settings need to consider context appropriate strategies that support mothers with small children.

Israeli and British women's wellbeing and eating behaviours in pregnancy and postpartum

OBJECTIVES

The study had two main objectives: (a) track changes in self-esteem, eating behaviours and body satisfaction from early pregnancy to 24 months postpartum and (b) to compare changes by context (Israel vs. UK) and maternal body mass index (BMI).

BACKGROUND

High maternal BMI is associated with negative body image and restrained eating, which are experienced differently across cultures.

METHODS

156 pregnant women were recruited from Israel and the UK. Seventy-three women were followed up every six months from early postpartum and until 24 months following birth. Women completed questionnaires assessing self-esteem (RSEQ), body image (BIS/BIDQ) and eating behaviours (DEBQ) and self-reported weights and heights so that BMI could be calculated.

RESULTS

Women with higher BMI had higher levels of self-esteem and were less satisfied with their body. Healthy-weight women were more likely to lose all of their retained pregnancy weight compared to overweight and obese women. Self-esteem, body image and eating behaviours remained stable from pregnancy until 24 months postpartum. No significant differences were found for any measure by context.

CONCLUSION

BMI was the strongest predictor of self-esteem and body dissatisfaction and a higher BMI predicted less weight loss postpartum.

Infant hunger and satiety cues during the first two years of life: Developmental changes of within meal signalling

Overfeeding in infancy may lead to overweight and obesity in later childhood. Mothers are advised to "tune in" to their infant's hunger, appetite and satiation cues to prevent overfeeding. The present study aimed to 1) assess stability and change in infant hunger and satiety cues (first two years of life) taken at six monthly intervals; 2) track the expression of appetite cues during the course of a meal (beginning, middle and end). Thirty-eight women (mean age 35.3 + 3.7 years) participated in the study. Mothers were within a normal weight range (BMI = 22 + 3.3 kg/m²), most were married (N = 35; 95%) and for most this was not their first child. After an initial investigation (T1) follow-up visits took place every six months with filmed meals involving solid foods. A typical meal contained foods high in protein and carbohydrate plus cooked vegetables. Films were viewed and communication cues (engagement indicating appetite and disengagement indicating satiation) identified and recorded by appearance using the NCAST (Nursing Child Assessment Satellite Training). Coding included the frequency and time at which each cue appeared. Results showed that infants were more likely to communicate potent engagement cues such as babbling, mutual gaze and looking at mother with age. None of the disengagement cues showed any significant main effects of time of follow up. Most, not all, feeding cues were stable across the segment of the feed and did not show a simple linear change across the meal, rather this appeared to develop with age. Raising awareness of these cues with mothers may encourage more responsive and positive mealtime interactions.

The associations between depressive and anxiety symptoms, body image, and weight in the first year postpartum: a rapid systematic review

OBJECTIVE

The aim of this study was to conduct a rapid systematic review of the evidence of associations between postpartum depressive symptoms, anxiety symptoms, body image and weight status in the first 12 months post birth.

BACKGROUND

The postpartum period places the mother and infant at risk of a number of negative health outcomes. Mental health conditions such as depression and anxiety are common in the postpartum, as are poor body image and excessive weight retention as women adjust to their post pregnancy body. However, the associations between body image, weight status and psychological distress are not currently well understood.

METHODS

Articles in English, published between 2006 and 2017, involving singleton pregnancies of normally developing infants and maternal depression or anxiety were eligible for this systematic review.

RESULTS

From the total of 1805 articles located, 12 were identified as relevant and were subsequently reviewed in full. In the nine studies of depressive symptoms, body image or weight status, four found a significant relationship. Significant associations were not found in the three studies investigating postpartum anxiety symptoms, body image or weight. Body dissatisfaction was associated significantly with poorer postpartum weight status in all nine studies.

CONCLUSIONS

Further research is needed to determine the nature of the relationships between body image, weight status and depressive and anxiety symptoms across the first year after birth. This information will assist health professionals to promote healthy lifestyle behaviours in the postpartum, as well as inform clinical interventions that target behaviour change to prevent the worsening of these issues and related negative outcomes.

Looking for cues - infant communication of hunger and satiation during milk feeding

It is known that duration of breastfeeding and responsive feeding are associated with decreased risk of obesity. It is however, not clear whether breastfed infants signal more to mothers to facilitate responsive feeding, compared to formula fed, nor what communication cues are important during the feeding interaction. The present study aimed to explore feeding cues in milk-fed infants and to examine if such cues vary by mode of feeding. Twenty-seven mothers and infants were filmed while breastfeeding or formula feeding. Infants' age ranged from 3 to 22 weeks. Feeding cues were identified using a validated list of communication cues (NCAST). The frequency of each cue during the beginning, middle, and end of the meal was recorded. There were 22 feeding cues identified during the feeds, with significantly more frequent disengagement cues expressed than engagement cues. Significantly more frequent feeding cues were observed at the beginning than at the end of the meal showing that cue frequency changes with satiation. Breastfeeding infants exhibited more engagement and disengagement cues than formula fed infants. Supporting mothers to identify engagement and disengagement cues during a milk feed may promote more responsive feeding-strategies that can be acquired by mothers using different modes of feeding.

"It's like giving him a piece of me.": Exploring UK and Israeli women's accounts of motherhood and feeding

OBJECTIVE

The present study explored how Israeli and UK mothers integrate feeding into their conceptualisations of mothering 2-6 months post-partum.

BACKGROUND

The nature and importance of motherhood is subject to differential contextual, cultural, political and historical influences. We set out to compare experiences of motherhood and feeding between these two countries using a qualitative approach.

METHODS

Forty one women (mean age 36.4 ± 2.7 years) from Israel and the UK, mostly married or in a committed relationship were interviewed about their experience of pregnancy, motherhood and feeding. Data were analysed thematically.

RESULTS

The experience of motherhood in the early postnatal period was dominated, for all mothers, by the experience of breastfeeding and clustered around three representations of mothering, namely; 1) a devoted mother who ignores her own needs; 2) a mother who is available for her infant but acknowledges her needs as well; and 3) a struggling mother for whom motherhood is a burden. Such representations existed within both cultural groups and sometimes coexisted within the same mothers. UK women described more struggles within motherhood whereas a tendency towards idealising motherhood was observed for Israeli women.

CONCLUSION

There are similarities in the ways that UK and Israeli women experienced motherhood and feeding. Where family life is strongly emphasized, mothers reported extremes of idealism and burden and associated an "ideal" mother with a breastfeeding mother. Where motherhood is represented as just one of many roles women take up, they are more likely to represent a "good enough" approach to mothering. Understanding the experience of motherhood and feeding in different cultural settings is important to provide the context for postnatal care specifically where mothers are reluctant to share problems or difficulties encountered.

Breast is best: Positive mealtime interactions in breastfeeding mothers from Israel and the United Kingdom

We examined mealtime interactions to assess whether they varied according to maternal body mass index, country and mode of feeding in 41 Israeli and UK mother–infant dyads. Feeding behaviours were coded using the Simple Feeding Element Scale. Significantly, more UK mothers breastfed during the filmed meal compared to Israeli mothers. Mealtime interactions did not vary according to maternal body mass index or country. Women who breastfed (as opposed to those who bottle fed or fed solids) provided fewer distractions during the meal, a more ideal feeding environment and fed more responsively.