Does your child's weight influence how you judge yourself as a parent? A cross-sectional study to define and examine parental overvaluation of weight/shape

Beyond Binge Eating: The Impact of Implicit Biases in Healthcare on Youth with Disordered Eating and Obesity

(1) Background: Obesity and eating disorders (ED) can coexist resulting in worse health outcomes. Youth with ED are more likely to have obesity relative to peers with a healthy weight. Pediatric providers deliver first-line care to children and youth of all sizes and body shapes from infancy to adolescents. As healthcare providers (HCPs), we bring biases into our practice. Learning to recognize and address these biases is needed to provide the best care for youth with obesity. (2) Purpose: This paper aims to summarize the literature regarding the prevalence of ED beyond binge eating in youth with obesity and discuss how the intersection of weight, gender, and racial biases impact the assessment, diagnosis, and treatment of ED. We provide recommendations for practice and considerations for research and policy. (3) Conclusions: The assessment and treatment of ED and disordered eating behaviors (DEBs) in youth with obesity is complex and requires a holistic approach. This approach begins with identifying and understanding how one's implicit biases impact care. Providing care from a patient-centers lens, which considers how the intersection of multiple stigmatized identities increases the risk for DEBs in youth with obesity may improve long-term health outcomes.

Does your past define you? How weight histories are associated with child eating-disorder psychopathology

PURPOSE

To examine how parents' and adolescents' weight histories were associated with parents' approach to eating/weight-related parenting and children's eating-disorder behaviors.

METHODS

Participants were 502 parents (69.3% mothers, 30.7% fathers) of children 12-16 years old who completed an online survey. Parents reported their own and their child's weight status during childhood and adolescence. Parents' and children's weight histories were categorized as "weight loss," "weight stability," or "weight gain" and were examined in relation to feeding practices and eating-disorder psychopathology.

RESULTS

Parents with a history of weight gain had greater personal eating-disorder psychopathology and more concerns about their child's weight than parents with weight stability or loss. They also reported greater parental overvaluation (judgment of themselves as parents according to their child's weight/shape). Children with a history of weight loss or gain were more likely to have eating-disorder behaviors than those with stable weight. Analyses revealed that results largely persisted after adjusting for child BMI-z.

CONCLUSIONS

Both parent and child weight gain between childhood and adolescence were associated with eating-disorder psychopathology, eating/weight-related parenting, and feeding practices. Pediatricians and clinicians should assess weight history when considering risk for eating disorders and obesity.

LEVEL OF EVIDENCE

Level III, Evidence obtained from well-designed cohort or case-controlled analytic studies.

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.

"I Feel Like Less of a Mom": Experiences of Weight Stigma by Association among Mothers of Children with Overweight and Obesity

Background: Parents of children with higher weight are blamed and shamed for their children's weight. However, parents' experiences of this form of stigma, termed weight stigma by association, are poorly understood. The objective of this study was to investigate the sources, forms, and impacts of weight stigma by association among mothers of children with overweight or obesity. Methods: In this qualitative study, mothers who reported concern about their children's weight participated in semistructured interviews administered by the research team. A coding scheme was developed and reliably applied to interview transcripts. Mothers' self-reported sociodemographic information, and height and weight were measured. Results: Thirty-four mothers (Mage: 43.4 years; 26.5% non-Hispanic Black or African American, 70.6% with obesity) participated in the study. Mothers reported that family members were a common source of negative comments about their children's weight; these comments were often critical of mothers' parenting and in some cases contributed to negative affect among mothers. Many mothers also reported negative experiences during children's physicians' visits as a result of their children's weight. Almost all mothers expressed guilt and sadness for their perceived role in their children's weight status, expressing regret that they did not parent differently. Conclusions: Mothers of children with overweight and obesity are frequently the target of weight stigma by association and experience negative cognitions and emotions regarding their perceived role in their children's weight. Continued research is needed to elucidate the impacts of stigma by association due to child weight on parents' health, the parent/child relationship, and children's health.

Parents' perceptions of parent-child interactions related to eating and body image: an experimental vignette study

Parents are key to children's health because they can influence children's eating behavior and body image and can make health-related decisions for children. Despite their influence, research on parents' opinions about parenting practices related to weight and eating is limited. Experimental vignettes examined parents' perceptions of parent-child interactions around body image, eating, and weight loss. We manipulated vignette-child weight (healthy-weight, overweight) and communication tone (positive, negative, neutral) to assess their influence on parents' perceptions. Parents (N = 233, 27.5% fathers, 72.5% mothers) were randomly assigned to read one of six vignettes. When the vignette-child had overweight, parents were more likely to recommend seeking help for body image and that the vignette-parent should choose the restaurant food order. Parents were less opposed to commenting on the vignette-child's weight when tone was positive. Parents were more likely to recommend weight-loss efforts that could be implemented by the family rather than those requiring professional assistance. This study is among the first to examine parents' opinions about parenting practices related to weight and eating using an experimental design. Findings might inform future research and continued work on prevention and treatment applications to help align parents' existing opinions about weight and eating with evidence-based health-promoting strategies.

Parents Can Experience Impairment Because of Their Children's Weight and Problematic Eating Behaviors

PURPOSE

Pediatric obesity and eating disorders have adverse consequences on children's health and psychosocial functioning. Parents are involved in children's daily lives and their health, but the extent to which children's eating behaviors or weight impact parents' daily functioning is unknown.

METHODS

The present study examined parent and child impairment because of child eating problems and weight in key life domains, including work/school, social life, and family life. Participants were parents (N = 861; 35.5% fathers) who completed an online cross-sectional survey, including perceived impairment because of their child's weight and eating behaviors.

RESULTS

Overall, 7.0% of parents reported clinically significant impairment because of child weight, and 6.9% reported clinically significant impairment because of child eating behaviors. Significantly more parents of children categorized as having obesity reported clinically significant parent and child impairment than other weight categories. Parents of children who regularly engaged in secretive eating reported greater child impairment than those without problematic eating. When child weight and problematic eating behaviors were analyzed jointly with parent sex, child sex, and parents' overinvestment in their child's weight, parents' overinvestment in child weight was associated significantly with parent and child impairment, and secretive eating maintained a significant association, but weight status was no longer associated significantly with impairment.

CONCLUSIONS

Understanding and considering individual and family impairment associated with obesity and problematic eating behaviors is critical for family-based prevention and treatment programs.