Early Parental Eating Messages and Disordered Eating: The Role of Body Shame and Inflexible Eating

Parental verbal communication and modeling behavior during mealtimes shape offspring eating behavior - A systematic review with a focus on clinical implications for eating disorders

OBJECTIVE

The aim of this review is to provide an overview of parental communication patterns during mealtimes, with a special emphasis being placed on the differences between families with and without a history of eating disorders.

METHODS

The systematic review was conducted according to the PRISMA statement. A systematic literature search was carried out in PubMed, PubPsych and PsycINFO and the results were assessed for eligibility by two independent raters using the PICOS criteria. Only studies that included a mealtime observation were considered suitable for analysis of both explicit and implicit parental communication.

RESULTS

The results of the review suggest that mothers communicate more, with more complexity, and with a greater variety of words with their children during mealtimes compared to fathers. The intention and type of communication is diverse and heterogeneous. In general, parents often tried to encourage their children to eat. Verbal modeling and co-eating appeared to be common behaviors. Mothers with a history of eating disorders expressed more negative emotions during eating than mothers without eating disorders. Findings regarding the use of positive comments and controlling speech are contradicting.

DISCUSSION

The review outlines major fields of parent-child communication and modeling behavior around family meals which might be relevant to investigate and integrate into models of intergenerational transmission of eating behavior and disordered eating.

Prospective associations between early childhood parental feeding practices and eating disorder symptoms and disordered eating behaviors in adolescence

OBJECTIVE

Nonresponsive parental feeding practices are associated with poorer appetite self-regulation in children. It is unknown whether this relationship extends beyond childhood to be prospectively associated with the onset of eating disorder (ED) symptoms in adolescence. This exploratory study therefore investigated prospective associations between early childhood parental feeding practices and adolescent ED symptoms and disordered eating behaviors.

METHODS

Data were from two population-based cohorts with harmonized measures: Generation R (Netherlands; n = 4900) and Gemini (UK; n = 2094). Parents self-reported their pressure to eat, restriction and instrumental feeding (i.e., using food as a reward) at child age 4-5 years. Adolescents self-reported their compensatory behaviors (e.g., fasting, purging), binge-eating symptoms, restrained eating, uncontrolled eating, and emotional eating at 12-14 years. Associations between feeding practices and ED symptoms were examined separately in each cohort using generalized linear models.

RESULTS

In Gemini, pressure to eat in early childhood was associated with adolescents engaging in compensatory behaviors. In Generation R, parental restriction was associated with adolescents engaging in compensatory behaviors, restrained eating, uncontrolled eating, and emotional eating. Instrumental feeding was associated with uncontrolled eating and emotional eating in Generation R.

DISCUSSION

Nonresponsive parental feeding practices were associated with a greater frequency of specific ED symptoms and disordered eating in adolescence, although effect sizes were small and findings were inconsistent between cohorts. Potentially, the cultural and developmental context in which child-parent feeding interactions occur is important for ED symptoms. Further replication studies are required to better understand parents' role in the development and maintenance of ED-related symptoms.

PUBLIC SIGNIFICANCE

Prospective research examining how early childhood parental feeding practices might contribute to adolescent ED symptoms is limited. In two population-based cohorts, nonresponsive feeding practices (restriction, instrumental feeding, pressure to eat) predicted increased frequency of some ED symptoms and disordered eating behaviors in adolescence, although associations were small and further replication is required. Findings support the promotion of responsive feeding practices, which may benefit young children's developing relationship with food.

"If You Don't Lose Weight, the Government Will Take You Away": An Analysis of Memorable Messages and Eating Disorders in the LGBTQ+ Community

Family communication plays a key role in children's body image, disordered eating, and full-blown eating disorders;. However, much existing communication research on eating disorders has focused on general populations. As the LGBTQ+ community is disproportionately affected by eating disorders , more work is needed to better understand how family communication may be perceived as influencing eating disorders in the LGBTQ+ community. Thus, the current study aimed to further this understanding by examining familial memorable messages reported by LGBTQ+ individuals which they perceived to have influenced their eating disorders. In a Qualtrics survey, participants (n = 73) provided memorable messages received from family members and explained their significance. Results of a thematic analysis indicate five themes among the memorable messages: Problematic Body Size/Weight, Pathologized Eating, Emphasizing Appearance Ideals, Emotion Origins, and Other Focus. Findings support the theory of memorable messages and reveal the ways in which diet culture and LGBTQ+ identity stigma intersect within parent-child communication toward a perceived influence on LGBTQ+ eating disorders. Implications for future communication research on LGBTQ+ eating disorders, as well as practical applications, are discussed.

Negative messages from parents and sisters and Latina college students' body image shame

Using the sociocultural model and risk and resilience theory, we examined the moderating role of Latinas' family relationship quality on the associations between negative eating and weight messages from fathers, mothers, and sisters, and Latinas' body image shame. Utilizing Amazon Mechanical Turk, we recruited a sample of 195 Latina young adults (M_age = 23.24, range = 18 -25; SD = 1.95; 67.4 % Mexican-origin) who reported retrospectively on negative appearance-related messages from each family member (i.e., fathers, mothers, and sisters), positive (e.g., parental warmth and sibling intimacy) and negative (i.e., parental psychological control and sibling negativity) relationship quality with parents and sisters, and current body image shame. Hierarchical linear regression analyses revealed that negative eating and weight messages from fathers, mothers, and sisters and sibling negativity were positively and significantly associated with Latinas' body image shame. Further, we found that under conditions of high paternal psychological control but not low, the associations between fathers' messages and Latinas' body image shame were strengthened. For mothers, under conditions of low maternal psychological control but not high, the associations between mothers' messages and Latinas' body image shame were strengthened. Our findings reveal that family members' negative comments are harmful for Latinas' body image.

Validation of the inflexible eating questionnaire in a large sample of Chinese adolescents: psychometric properties and gender-related differential item functioning

PURPOSE

The aim of this study was to provide preliminary psychometric evidence for the Chinese version of the Inflexible Eating Questionnaire (C-IEQ) among a large sample of Chinese adolescents.

METHODS

For testing the psychometric properties of the C-IEQ, a total of 2241 (M_age = 13.91 years; 46.4% boys) adolescents from mainland China responded to the survey. Confirmatory factor analysis (CFA) was used to examine the factor structure of the C-IEQ. Measurement invariance by gender was examined by both multi-group CFA and differential item functioning (DIF). Convergent validity of the C-IEQ was assessed via examining the correlations between the C-IEQ scores and theoretically related constructs (e.g., orthorexia nervosa symptomatology, eating disorder symptomatology, and body image inflexibility).

RESULTS

The unidimensional structure with correlated errors of the C-IEQ showed good model fit (χ² = 1674.05, df = 44, p < 0.001; CFI = 0.93; TLI = 0.91; RMSEA = 0.13; SRMR = 0.06). The C-IEQ had an adequate internal consistency (α = 0.89) and demonstrated strong measurement invariance across genders. Moreover, the scores of the C-IEQ showed significant correlations with theoretically correlated constructs: orthorexia nervosa symptomatology (girls; r = 0.53 p < 0.001, boys; r = 0.45 p < 0.001), eating disorder symptomatology (girls; r = 0.32 p < 0.001, boys; r = 0.25 p < 0.001) body image inflexibility (girls; r = 0.41 p < 0.001, boys; r = 0.36 p < 0.001), suggesting good convergent validity of the C-IEQ.

CONCLUSION

The C-IEQ showed good psychometric properties in a sample of Chinese adolescents and can be used in future studies to assess eating-specific psychological inflexibility among Chinese adolescents.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Acceptance of cosmetic surgery in adolescents: The effects of caregiver eating messages and objectified body consciousness

Cosmetic procedures are aimed at enhancing clients’ attractiveness by modifying their physical appearance. Women prefer cosmetic surgery more than men do, due to the ideal of leanness advertised by the media. Female adolescents, undergoing an emotionally unstable developmental stage, are particularly responsive to unrealistic beauty standards. The more they internalize cultural norms, the more they objectify their bodies. Young people’s views on their bodies are essentially influenced by the feedback received from their parents and other adults. The present study explored the impact of caregiver eating messages and objectified body consciousness on the acceptance of cosmetic surgery among Hungarian female students aged 14 to 19 years (M = 16.79, SD = 1.245). Self-report scales used to collect data in four secondary schools. The expected associations were tested with path analysis. Caregiver eating messages generally had an indirect positive impact on the acceptance of cosmetic surgery that was mediated by the shame component of objectified body consciousness. A direct impact was only shown by critical/restrictive caregiver messages and by the shame component of objectified body consciousness. The other two components of objectified body consciousness were unrelated to the acceptance of cosmetic surgery. In sum, caregiver messages on female adolescents’ appearance and eating habits have a formative role on their attitudes towards cosmetic surgery. Such messages predict their proneness to view their bodies as objects serving to meet certain beauty standards. The more they endorse such views, the more they are willing to consider cosmetic surgery to enhance their appearance.

Shame and eating disorders symptoms: A meta-analysis

OBJECTIVE

Numerous empirical studies and theoretical models posit that shame is a common experience among individuals across the eating disorder spectrum. In this study we aim to investigate the association between shame and eating disorders symptoms using a meta-analytical approach.

METHOD

In this meta-analysis, we synthesized findings from 195 studies to examine the proposed association between shame and eating disorders symptoms. We looked at the associations with both general eating disorders symptoms and with specific eating disorders symptoms (i.e., anorexic, bulimic, and binge-eating symptoms). Moderation analyses testing for the effect of type of shame, type of eating symptoms, clinical status, quality of the study, age, and gender were conducted.

RESULTS

Shame was significantly associated with a medium to large effect size with all types of eating disorders symptoms (rs between .40 and .52). Body shame (r = .55) and shame around eating (r = .59) were more strongly related with eating disorders pathology. Type of eating disorders symptoms did not moderate the relationship between shame and disturbed eating.

DISCUSSION

Overall, the magnitude of the effect size of the association between shame and eating disorders symptoms is a medium to large one. Body shame and shame around eating seem to be the types of shame most closely tied with eating disorders symptoms, suggesting that directly targeting them in interventions might be highly beneficial. Findings highlight current gaps in the literature (e.g., mostly correlational studies, low quality studies) with implications for future research.

Overt restrictive feeding for weight management: a preliminary retrospective examination of childhood experiences

PURPOSE

Overt restrictive feeding practices (ORFP), aimed at promoting weight loss or preventing weight gain for children, are often implemented by parents with good intentions. Despite findings that indicate unintended weight and behavioral outcomes little is known about how parental ORFP are experienced by those who are subjected to them. Thus, we explored retrospective accounts of meaning making related to experiences of such practices during childhood.

METHODS

Six young adult females who experienced ORFP were interviewed. Data were analyzed using constructivist grounded theory.

RESULTS

Participants retrospectively associated experiencing ORFP with a meaning making process that involves: (a) perceiving parental motivation for ORFP and receiving messages about weight, (b) internalizing parental messages about weight, and (c) viewing self-worth as contingent on weight.

CONCLUSION

Preliminary findings suggest that parents may be reinforcing weight stigma in their children through ORFP. Results add evidence against the use of parental ORFP for childhood weight management.

LEVEL OF EVIDENCE

Level V, Descriptive study.