Maternal psychological factors and controlled child feeding practices in relation to child body mass index

Child and Maternal Factors Associated with Feeding Practices in Children with Poor Growth

The development of adequate growth and healthy eating behaviors depends on nutritious food and responsive feeding practices. Our study examined (1) the relationship between maternal concern about child weight or perceived feeding difficulties and their feeding practices, and (2) the moderating role of child temperament and maternal mental health on their feeding practices. A cross-sessional study included mother-child dyads (n = 98) from a tertiary growth and feeding clinic. Children had a mean age of 12.7 ± 5.0 months and a mean weight-for-age z-score of -2.0 ± 1.3. Responsive and controlling feeding practices were measured with the Infant Feeding Styles Questionnaire. Spearman correlation and moderation analysis were performed. Maternal concern about child weight and perceived feeding difficulties were negatively correlated with responsive feeding (r = -0.40, -0.48, p < 0.001). A greater concern about child weight or perceived feeding difficulties was associated with greater use of pressure feeding practices when effortful control was low (B = 0.49, t = 2.47, p = 0.01; B = -0.27, p = 0.008). Maternal anxiety had a significant moderation effect on the relationship between feeding difficulty and pressure feeding (B = -0.04, p = 0.009). Higher maternal concern about child weight and perceived feeding difficulties were associated with less responsive satiety feeding beliefs and behaviors. Both child effortful control and maternal anxiety influenced the relationship between weight and feeding concerns and the use of pressure feeding practices.

Maternal mood, body image, and eating habits predict changes in feeding practices during the COVID-19 pandemic

Maternal mood and eating habits are associated with food parenting practices, including non-responsive feeding practices, which in turn impact children's eating habits. The COVID-19 pandemic may have negatively impacted maternal mood due to the overall stress and challenges, contributing to changes in eating behaviors and food parenting practices. The present study examined how maternal mood, body image, and eating concerns were related to perceived changes in feeding practices during the pandemic. A total of 137 mothers participated in an online study. Participants retrospectively reported their mood, eating habits, body dissatisfaction, and non-responsive feeding practices, before and during the pandemic, and responded to open-ended questions regarding changes in eating and feeding patterns during the pandemic. Results suggested differences in non-responsive feeding practices, including higher use of food as a reward for behavior and lower use of standard meal settings during the pandemic. In addition, significant relationships were found between higher maternal stress and higher body dissatisfaction (r = 0.37; p < .01), restrained eating (r = 31; p < .01), emotional eating (r = 0.44; p < .01), and higher use of overt and covert restriction retrospectively and during the pandemic. Results revealed trends in the same direction for depression and anxiety. Finally, qualitative findings were consistent with the quantitative findings, suggesting relationships between maternal mood, eating habits, and feeding practices. These results provide support for previous findings suggesting that the pandemic negatively impacted maternal well-being, increasing the use of some non-responsive feeding practices. Further work exploring the impacts of the pandemic on well-being, child feeding, and eating patterns is warranted.

Mindful feeding: Associations with COVID-19 related parent stress and child eating behavior

Parent perceived stress has been associated with child obesogenic eating, as parents who are stressed may be less responsive to their children during mealtimes (Gemmill et al., 2013). More recently, mindfulness-based interventions have successfully reduced people's stress levels. However, less is known regarding the role of mindfulness in the child feeding context. In this study, 249 parents of children between the ages of 3 and 12 completed a 20-minute online study to examine the associations among COVID-19 related parent stress (hereby referred to as parent stress), mindful feeding, and child obesogenic eating (i.e., food responsiveness, enjoyment of food, emotional overeating, and desire to drink). As hypothesized, we found that greater parent stress was associated with lower mindful feeding and greater child obesogenic eating. Furthermore, findings showed that parent stress interacted with mindful feeding to predict certain child obesogenic eating (i.e., food responsiveness, emotional overeating). Emotional overeating and food responsiveness were higher in children among parents with higher stress levels and lower levels of mindful feeding when compared to children of parents with greater mindful feeding. Taken together, these findings suggest the potential of mindful feeding in buffering the association between parent stress and child obesogenic eating.

The association between parents' stress and parental feeding practices and feeding styles: Systematic review and meta-analysis of observational studies

In the extended UNICEF framework of early childhood nutrition, parents' stress is associated with parental feeding style. However, no comprehensive review has examined the association between parents' stress and feeding styles and practices. The objective of our review was to synthesise the current literature examining the association between parents' stress and their feeding practices and/or styles, among parents of children ≤ 5 years old. We searched; MEDLINE, EMBASE, PSYCHINFO and CINAHL from 2019 to 2021. Two investigators independently extracted relevant data and assessed the study quality and the certainty of evidence. Data were pooled using generic inverse variance with fixed effects (<5 comparisons) or random effects (≥5 comparisons) and expressed as correlation coefficients with 95% confidence intervals (CI). Between study heterogeneity was assessed using Cochran's Q and quantified with I² . We identified 6 longitudinal and 11 cross-sectional studies, of which 4 studies provided sufficient data to be pooled. A very small correlation between general stress and restrictive feeding practices was observed (r = 0.06 [95% CI: 0.01-0.12]; no substantial heterogeneity (I²  = 0.00%, P_Q  < 0.85, very low certainty). No correlation between general stress and feeding pressure was identified (r = 0.06 [95% CI: -0.02 to 0.15]). Results showed that both general and parenting stress were associated with suboptimal breastfeeding practices and unresponsive feeding styles. Conclusion: This study demonstrated a low-to-moderate quality of literature for the inclusion of parents' stress in the extended UNICEF care model of child nutrition. Future research needs to explore this relationship longitudinally and in ethnic diverse populations to inform tailored interventions that promote responsive feeding practices.

Changes in Feeding Behavior and Feeding Stress Among Mothers of Preschoolers Before and During the Novel Coronavirus Pandemic

Objective

To examine changes in maternal feeding behaviors (MFB) and maternal feeding stress (MFS) among mothers of preschoolers in Saudi Arabia before and during the novel coronavirus pandemic.

Methods

This is a prospective cohort study including 64 mothers of preschoolers who were drawn from a sample of a 2019 study. Study questionnaire was completed during November–December 2020. MFB were assessed using the Child Feeding Questionnaire-Arabic (CFQ-A) and MFS was assessed using the MFS-mealtimes index and the MFS-maternal resentment/difficult child index. Paired samples t-tests were used to examine changes in MFB and MFS.

Results

Mothers have reported an increase in perceived responsibility (M = 4.09, SD = 0.87 vs. M = 4.33, SD = 0.59, P-value < 0.05) and monitoring (M = 4.23, SD = 0.73 vs. M = 4.48, SD = 0.66, P-value < 0.05) during the pandemic period compared to the period prior to the pandemic. Mothers have reported a decrease in use of food as a reward (M = 4.11, SD = 0.87 vs. M = 2.30, SD = 0.88, P-value < 0.001) and concern about child's diet (M = 3.34, SD = 1.12 vs. M = 2.55, SD = 1.04, P-value <0.001). There was an increase in MFS-maternal resentment/difficult child (M = 2.47, SD = 0.68 vs. M = 2.71, SD = 0.72, P-value < 0.01).

Conclusions

Findings can help inform future research aiming to measure the long-term effects of the pandemic on child outcomes.

Parental feeding practices and child eating behavior in different socioeconomic neighborhoods and their association with childhood weight. The STEPS study

Child obesity risk, child eating behavior and parental feeding practices show a graded association with individual level socioeconomic status. However, their associations with neighborhood socioeconomic disadvantage are largely unknown. In this study (n = 682), we investigated how parental feeding practices and child eating behaviors were associated with body mass index and risk of overweight at preschool age in affluent and disadvantaged neighborhoods. We found that high food approach tendency in disadvantaged neighborhoods predicted higher body mass index and increased the risk of overweight at the age of 6 years compared with affluent neighborhoods. Our results suggest that children's eating habits may have stronger impact on overweight risk in disadvantaged than in affluent neighborhoods.

The Perceptions and Needs of French Parents and Pediatricians Concerning Information on Complementary Feeding

Appropriate complementary feeding (CoF) is the key to preventing childhood obesity and promoting long-term health. Parents must be properly informed through the CoF process. Pediatricians have opportunities to interact with parents during the CoF transition and influence parental feeding decisions. They can convey public health nutrition messages to parents. With the release of new CoF recommendations in France in 2019, and from the perspective of their conversion into official public health communication material, the aim of this study was to explore parents’ and pediatricians’ perceptions and needs regarding information on CoF. Two online surveys were disseminated to gather information on CoF communication and guidance: one for parents (n = 1001, January 2020); one for pediatricians (n = 301, October 2019). The results showed that the importance of CoF for children’s healthy growth was well recognized by both parents and pediatricians. Parents acknowledged pediatricians as the most influential source of advice; and pediatricians were aware of their responsibility in counselling parents on CoF. However, pediatricians neglected the fact that parents gave high trust to their personal network when looking for advice. The Internet was a well-recognized source of information according to all. Diverging from what pediatricians considered useful, parents were interested in practical advice for implementing CoF. This study highlights common expectations and points of divergence between parents’ needs and pediatricians’ perceptions of those needs with regard to CoF information.

The role of parental depression during early childhood obesity treatment-Secondary findings from a randomized controlled trial

BACKGROUND

Parental depression is a risk factor for childhood obesity.

OBJECTIVES

To examine the influence of parental depression on child weight status, eating behaviours, and parental feeding practices during childhood obesity treatment.

METHODS

Hundred and twenty eight children with obesity aged 4 to 6 years and their parents were randomized to a parent support program or to standard treatment. At baseline and after 12 months, children's heights and weights were measured. Parents reported levels of depression (Beck's Depression Inventory-II), feeding practices (Child Feeding Questionnaire), and children's eating behaviors (Child Eating Behavior Questionnaire). Independent and dependent paired sample t-tests and linear regressions were used to analyze data.

RESULTS

After obesity treatment, mothers reported lower levels of depression, whereas fathers did not. No associations were found between parental level of depression and child weight status, or between baseline level of parental depression and feeding practices. Associations were found between baseline parental depression and children's food responsiveness (β = .03; P = .01; 95% CI [0.01, 0.05]), emotional overeating (β = .02; P = .02; 95% CI [0.004, 0.04]), and desire to drink (β = .02; P = .03; 95% CI [0.002, 0.04]) (adjusted for background variables).

CONCLUSIONS

Parental depression did not influence child weight status or parental feeding practices but was associated with obesity-related child eating behaviors.

A positive deviance-based qualitative study of stress, coping, and feeding practices among low-income, Hispanic mothers whose children do versus do not meet guidelines for fruit and vegetable intake

Less than 1% of children in the United States concurrently meet guidelines for fruit/vegetable intake, physical activity, screen time, and sugar-sweetened beverages. Prior evidence suggests that parents of this 1% potentially cope with stress differently. This qualitative study used a positive deviance-based approach to locate mothers whose children avoided negative feeding outcomes despite being 'high-risk' for obesity. Semi-structured interviews were conducted in Spanish for two groups: low-income, Hispanic mothers whose children were normal weight and met recommendations for fruits/vegetables and physical activity (n = 5); and a comparison group whose children had obesity and did not meet guidelines (n = 8). Topics included weight-related parenting practices, attitudes toward health, and stress management. Interviews were transcribed, translated, and coded using NVivo for theoretically driven thematic analysis. Results suggested that mothers viewed stress differently. Mothers of healthy weight children believed stress could be prevented, such as by paying children more attention or directing one's attention away from stressors; comparison group mothers tended to report stress about managing their child's eating and about financial worries. Future research is needed to understand the underlying sources of these differences (e.g. personality traits, coping practices) and test whether stress prevention interventions can promote healthy parental feeding practices.

Systematic review: Symptoms of parental depression and anxiety and offspring overweight

OBJECTIVE To evaluate the existing literature on the association between parents' depression and anxiety and their influence on their children's weight during childhood, identifying possible mechanisms involved in this association. METHODS A systematic search of the literature was conducted in the PubMed, PsycINFO and SciELO databases, using the following descriptors: (maternal OR mother* OR parent* OR paternal OR father) AND ("common mental disorder" OR "mental health" OR "mental disorder" OR "depressive disorder" OR depress* OR anxiety OR "anxiety disorder") AND (child* OR pediatric OR offspring) AND (overweight OR obes* OR "body mass index" OR BMI). A total of 1,187 articles were found after peer selection. RESULTS In total, 16 articles that met the inclusion criteria were selected for the review. Most of them investigated depressive symptoms and only three, symptoms of maternal anxiety. The evaluated studies suggested a positive association between symptoms of maternal depression and higher risk of childhood obesity. The results diverged according to the chronicity of depressive symptoms (episodic or recurrent depression) and income of the investigated country (high or middle income). Mechanisms were identified passing by quality of parenthood, affecting behaviors related to physical activity and child-feeding, as mediators of the association. CONCLUSIONS We conclude there is evidence of a positive relationship between the occurrence of maternal symptoms of depression and anxiety and childhood obesity. It is emphasized the need for a better understanding on the effect of depressive symptoms and the contextual factors involved in this relationship so that effective intervention strategies can be implemented.

Parental Feeding Practices in Relation to Maternal Education and Childhood Obesity

Parental beliefs, attitudes, and feeding practices play a vital role in childhood obesity. This study aimed to assess parental perceptions, concerns about weight, feeding practices using the Child Feeding Questionnaire (CFQ), and its association with body mass index (BMI) and maternal education in elementary school children. Participants aged 6–10 years (n = 169) were recruited and anthropometric measurements were obtained. Pearson’s correlation and hierarchical linear regression analysis were used to examine the association between BMI z-score and the seven factors of the CFQ. The BMI z-score was significantly associated with parental perceived child weight and concern about child weight. The BMI z-score had a significant negative association with parents pressuring children to eat. Parents of obese children reported significantly higher (p < 0.001) levels of perceived child weight (β = 0.312) and concern (β = 0.320) about their child’s weight compared to the normal weight and overweight groups. Parents of overweight children showed considerably less (β = −0.224; p < 0.005) pressuring towards their children to eat as compared to parents of normal weight children. Additionally, we found that the parental feeding practice (pressure to eat) was only dependent upon maternal education. The path analysis indicates that maternal education has a mediating effect on BMI z-score and pressure to eat is related to BMI z-score through maternal education. The findings demonstrate the association between the parents’ perceptions, concerns, and pressure to eat with BMI z-score of elementary school-aged children. Only the parental feeding practice pressure to eat was dependent upon the maternal education.

Child Body Fat and Body Mass Index: Which Determinants are Most Important?

The purpose of this study was to examine child and parent determinants of children's body fat percentage (BF%) along with their body mass index percentile (BMIp). Children's BF% and BMIp auger lifelong health risks when elevated, and one in five children are affected. Participants (N = 135) included 62% female children; 50.7% Caucasian, 31.7% Hispanic, and 8.5% African American. Children were aged 9-15 years (2% underweight, 47.9% normal weight, 19.7% overweight, and 24.6% obese). Parent BMI average was 30.67 (1.4% underweight, 20.4% normal weight, 23.9% overweight, 40% obese, and 7% extreme obesity); 77.5% of the participating parents were mothers. Following multiple imputations, path analyses were conducted of child and parent determinants of children's BF% and BMIp. Children's BF% and BMIp were related to parents' concern about overweight and children's perception of that concern. For children of overweight or obese parents, who are at highest risk for obesity, assessing the parents' concern is the highest priority.

Associations of Maternal Psychological Distress during Pregnancy with Childhood General and Organ Fat Measures

Background: Psychological distress during pregnancy may influence offspring adiposity. No studies assessed the associations with organ fat measures. We examined the associations of maternal psychological distress, depression, and anxiety during pregnancy with child general and organ fat measures. Methods: In 4161 mother-offspring pairs, psychological distress was self-reported in pregnancy. We obtained general fat measures, including BMI and fat mass index by dual-energy X-ray absorptiometry, and organ fat measures (in a subsample of 2447 children), including subcutaneous, visceral, and pericardial fat indices and liver fat fraction by magnetic resonance imaging at 10 years. Linear and logistic regression models were used. Results: Children of mothers with psychological distress had higher fat mass index [difference 0.14 (95% confidence interval {CI} 0.04-0.24) standard deviation scores (SDS)] and higher risk of obesity [odds ratio (OR) 1.73 (95% CI 1.09-2.74)]. Maternal anxiety was associated with higher BMI [difference 0.16 (95% CI 0.05-0.26) SDS], fat mass index [difference 0.19 (95% CI 0.10-0.28) SDS], and higher risks of overweight and obesity [OR 1.36 (95% CI 1.03-1.81), 1.78 (95% CI 1.13-2.81)]. Maternal anxiety was associated with higher subcutaneous and visceral fat indices and liver fat fraction [differences 0.16 (95% CI 0.03-0.29), 0.15 (95% CI 0.01-0.29), and 0.16 (95% CI 0.02-0.29) SDS]. No associations were observed for maternal depression. Conclusions: Psychological distress and anxiety, but not depression, during pregnancy were associated with higher child general and organ fat measures. A healthy mental state during pregnancy may be important for preventing child adiposity.

Longitudinal Analysis Between Maternal Feeding Practices and Body Mass Index (BMI): A Study in Asian Singaporean Preschoolers

Bidirectional studies between maternal feeding practices with subsequent child weight are limited, with no studies in Asian populations. In longitudinal analyses, we assessed the directionality of the associations between maternal feeding practices and body mass index (BMI) in preschoolers. Participants were 428 mother child dyads from the GUSTO (Growing Up in Singapore Toward healthy Outcomes) cohort. Feeding practices were assessed using the Comprehensive Feeding Practices Questionnaire (CFPQ) at age 5 y. Child BMI was measured at ages 4 and 6 y. BMI and maternal feeding practices subscales were transformed to SD scores and both directions of their associations examined with multivariable linear regression and pathway modeling. Higher BMI at age 4 was associated with lower encouragement of balance and variety (β = −0.33; 95%CI: −0.53, −0.13), lower pressure to eat (β = −0.49; −0.68, −0.29) and higher restriction (β = 1.10; 0.67, 1.52) at age 5, adjusting for confounders and baseline feeding practices at 3 years. In the reverse direction, only pressure and restriction at age 5 were associated with lower and higher child BMI at age 6 years, respectively. After the adjustment for baseline BMI at age 5, the association with pressure was attenuated to non-significance (β = 0.01 (−0.01, 0.03), while the association with restriction remained significant (β = 0.02; 0.002, 0.03). Overall, associations from child BMI to maternal restriction for weight control and pressure feeding practices was stronger than the association from these maternal feeding practices to child BMI (Wald's statistics = 24.3 and 19.5, respectively; p < 0.001). The strength and directionality suggests that the mothers in the Asian population were likely to adopt these feeding practices in response to their child's BMI, rather than the converse.

Clinical Trial Registry Number and Website 

This study was registered at clinicaltrials.gov as NCT01174875 (www.clinicaltrials.gov, NCT01174875).

How can mindful parenting be related to emotional eating and overeating in childhood and adolescence? The mediating role of parenting stress and parental child-feeding practices

To explore whether the association between mindful parenting and children/adolescents' disordered eating behaviors (i.e., emotional eating and overeating) may be mediated by parenting stress and parental child-feeding practices. The sample comprised 726 family dyads composed of a mother (79.8%) or a father (20.2%) and their child (7-18 years old), of which 362 children/adolescents had normal weight (BMI = 5-85th percentile) and 364 had overweight or obesity (BMI ≥ 85th percentile) according to the WHO Child Growth Standards. Parents completed self-report measures of mindful parenting, parenting stress, and child-feeding practices, and children/adolescents completed measures of emotional eating and overeating. The path model was estimated in AMOS. Mindful parenting was negatively associated with children's emotional eating through lower levels of parenting stress followed by less frequent use of food as a reward and through less frequent use of food as a reward only. Mindful parenting was linked to children's overeating through lower levels of parenting stress. Moreover, mindful parenting was associated with less frequent use of food as a reward, pressuring to eat and monitoring through lower levels of parenting stress, among parents of girls, mostly from the early stage of adolescence. Additionally, higher levels of parenting stress were associated with using food as a reward and, consequently, with higher levels of emotional eating among girls, and with more restriction and, consequently, with more overeating among early-stage adolescents. A comprehensive model suggesting that mindful parenting can help children/adolescents engage less in disordered eating behaviors through lower levels of parenting stress and the adoption of more adaptive child-feeding practices is proposed. Parental practices, particularly mindful parenting, may have an important role in promoting healthier eating behaviors among children/adolescents.

Parent Feeding Practices in the Australian Indigenous Population within the Context of non-Indigenous Australians and Indigenous Populations in Other High-Income Countries-A Scoping Review

Although extensive literature on parent feeding practices among the general Australian population exists, Australian Indigenous populations are generally overlooked. A systematic scoping review was carried out to map any source of literature showing Indigenous parent feeding practices in Australia in the context of what is known about parent feeding practices among broader Australian populations and Indigenous populations in other high-income countries.A search of 8 electronic health databases was conducted. Inclusion criteria were children aged <12 y and reporting ≥1 child outcome related to childhood overweight and/or obesity, body mass index, dietary intake, or eating behavior in the context of parent feeding practices. Studies were grouped according to Indigenous status of the population for data extraction and synthesis.A total of 79 studies were identified; 80% (n = 65) were conducted among the general Australian population and <20% (n = 14) focused on Indigenous populations. Although a wide range of feeding practices were identified among the general Australian population, Indigenous practices most closely aligned with highly responsive and permissive parenting dimensions. The highly valued child autonomy in Indigenous parenting is sometimes criticized by researchers when viewed through a Western lens because the child has agency in deciding what and when to eat.Evidence-based understanding and knowledge of Indigenous parent feeding practices in Australia are limited. Indigenous worldviews are expressed distinctly differently than the general Western worldview in parent feeding practices. How worldviews are represented in parent-child relationships is important to consider for the way in which research with Indigenous populations is conducted and the evidence it generates to inform policy and practice.

Pathways between maternal depression, the family environment, and child BMI z scores

PURPOSE

Modifiable aspects of the family environment that contribute to overweight in younger children have been identified, including parental feeding practices, child eating behaviors, and parenting practices related to eating and household routines. Maternal depression influences many of these factors, yet research examining pathways that may link maternal depression through the family environment to child weight is lacking. The current study examined parental feeding practices, child eating behaviors, and eating and household routines as potential mediators between maternal depressive symptoms and child weight at age six. The study also tested for differential effects of early versus concurrent maternal depressive symptoms.

METHODS

Longitudinal data on 1130 mothers and their children who participated in the Infant Feeding Practices Study II (IFSP II) and its Year 6 Follow-Up study were analyzed. A multi-step, multiple mediator model assessed direct and indirect relationships between early depressive symptoms (two months post-partum) and concurrent depressive symptoms with child Body Mass Index (BMI) z scores at age six. Potential mediators included parental feeding practices, child eating behaviors, and eating and household routines.

RESULTS

Higher early depressive symptoms directly explained lower child BMI z scores. Early depression also worked through concurrent depression, the child's food responsiveness, and the hours the child slept on week nights to explain higher child BMI z scores. Parental efforts to make sure the child eats enough directly predicted lower child weight but did not mediate the effects of early or concurrent maternal depressive symptoms.

CONCLUSIONS

The findings suggest the need for greater attention to the relationships between maternal depression and child weight as a critical step toward developing effective obesity prevention strategies.

The impact of positive contextual factors on the association between adverse family experiences and obesity in a National Survey of Children

Adverse family experiences (AFEs) are associated with childhood obesity. We evaluated whether certain positive contextual factors reduce the risk of obesity and overweight among children exposed to AFEs in a nationally representative sample. Using data derived from the National Survey of Children's Health 2011-12 (N = 43,864), we calculated the distribution of positive contextual factors (very good/excellent maternal mental health, neighborhood and school safety, and child resilience) and AFEs across weight status. The AFEs composite score was modeled as a categorical measure (0 or ≥1 AFEs). Positive contextual factors, AFEs and their interactions were evaluated in weighted, adjusted, multinomial logistic regression models predicting the odds of overweight and obesity. Children exposed to lack of very good/excellent maternal mental health and at least one AFE were at risk for overweight (OR = 1.43; 95% CI: 1.16, 1.76) and obesity (OR = 1.53; 95% CI: 1.22, 1.93). Unsafe school or neighborhood environment and exposure to 1 or more AFEs was. associated with overweight (OR = 1.32; 95% CI: 1.08, 1.61) and obesity (OR = 1.66; 95% CI: 1.34, 2.05). Lack of child resilience and exposure to 1 or more AFEs was associated with an increased risk of obesity (OR = 1.45; 95% CI: 1.17, 1.90) and overweight (OR = 1.29; 95% CI: 1.06, 1.57). These odds of obesity and overweight all decreased when positive contextual factors were present. Among children exposed to AFEs, overweight and obesity risk is reduced with positive contextual factors. Optimizing the early childhood environment can impact obesity risk.

Cognitive and affective factors linking mothers' perceived weight history to child feeding

BACKGROUND/OBJECTIVES

To explore whether mothers' lifetime experiences with their own weight status and related cognitive and affective factors influence child feeding behavior.

SUBJECTS/METHODS

Overweight mothers (N = 221) of 4-5 year olds recalled their weight at four time points, and were grouped into weight history trajectories: recently overweight, always overweight, and steady-gain-obese. Objective food choice behavior was assessed in a virtual reality buffet and subjective food restriction for the index child was assessed using a psychometric measure.

RESULTS

Mothers' observed food choice was not associated with weight trajectory, but mothers who spent more time being overweight and who weighed more at present were more restrictive of their child's eating. Mothers' concern about child weight increased with more time spent being overweight. Concern for child weight and mothers' body guilt differentially mediated the relationships between weight trajectories and perceived feeding restriction.

CONCLUSIONS

Considering mothers' lifetime weight experiences may suggest that parental influences on child feeding are amenable to intervention that would otherwise be obscured by static weight measures.

Maternal psychological distress during pregnancy and childhood health outcomes: a narrative review

Maternal psychological distress is common in pregnancy and may influence the risk of adverse outcomes in children. Psychological distress may cause a suboptimal intrauterine environment leading to growth and developmental adaptations of the fetus and child. In this narrative review, we examined the influence of maternal psychological distress during pregnancy on fetal outcomes and child cardiometabolic, respiratory, atopic and neurodevelopment-related health outcomes. We discussed these findings from an epidemiological and life course perspective and provided recommendations for future studies. The literature in the field of maternal psychological distress and child health outcomes is extensive and shows that exposure to stress during pregnancy is associated with multiple adverse child health outcomes. Because maternal psychological distress is an important and potential modifiable factor during pregnancy, it should be a target for prevention strategies in order to optimize fetal and child health. Future studies should use innovative designs and strategies in order to address the issue of causality.

A Structural Equation Modelling Approach to Understanding Influences of Maternal and Family Characteristics on Feeding Practices in Young Children

BACKGROUND

The family environment is influential for a child's healthy development through parent and sibling influences on feeding practices. Multiple-child households may protect against unhealthy feeding practices, but additional children contribute to higher maternal stress. Households of married parents may decrease maternal stress by sharing parental demands.

OBJECTIVE

We aimed to evaluate the collective influence of maternal stress, marital status, and number of children on feeding practices.

METHODS

Mothers of 2- to 5-y-old children (n = 278) were recruited mainly on a university campus and completed an online survey to examine associations between maternal stress (Depression, Anxiety, Stress Scale), number of children, marital status, and feeding practices (restriction and pressure to eat; Child Feeding Questionnaire). Relationships were examined through the use of multivariate regression and structural equation modelling.

RESULTS

A mainly married (85%) and Caucasian (73%) sample participated, with most mothers reporting multiple children [2 children (45%) or ≥3 children (24%)]. Marital status was not associated with either feeding practice, i.e., restriction and pressure to eat (P < 0.05). In adjusted models, maternal stress (β = 0.04, SE = 0.01, P = 0.003) and number of children (β = 0.24, SE = 0.08, P = 0.003) in the household individually contributed to higher feeding restriction; their interaction resulted in lower feeding restriction (β = -0.01, SE = 0.05, P = 0.005). In stratified models, maternal stress was associated with restriction in single-child households (β = -0.03, SE = 0.009, P = 0.002), but not multiple-child households (β = -0.004, SE = 0.005, P = 0.40).

CONCLUSIONS

Number of children had no effect on feeding practices individually, but may contribute to a less restrictive feeding environment. Additional investigation into creating less stressful and more positive feeding environments for all mothers can lead to healthier mothers and families.

Pathways of Association from Stress to Obesity in Early Childhood

OBJECTIVE

The objective of this study is to critically review the literature on early life stress in relation to obesity in humans, including the multiple biological and behavioral mechanisms through which early life stress exposure (birth to the age of 5 years) may associate with obesity risk during childhood.

METHODS

A review of the literature was conducted to identify studies on associations between early childhood stress and risk for obesity and the mechanisms of association. Multiple databases (PubMed, PsycInfo, Google Scholar) were used in the search as well as a "snowball" search strategy. All study designs were included.

RESULTS

Early life stress and adverse childhood experiences are associated with obesity and overweight in adults. Evidence is less consistent in children. Studies vary in the nature of the stress examined (e.g., chronic vs. acute), sample characteristics, and study designs. Longitudinal studies are needed, as the effects of early life stress exposure may not emerge until later in the life-span. Early life stress exposure is associated with biological and behavioral pathways that may increase risk for childhood obesity.

CONCLUSIONS

There is evidence that early life stress is associated with multiple biological and behavioral pathways in children that may increase risk for later obesity. Little work has detailed the interconnections among these mechanisms across development or identified potential moderators of the association. Mapping the mechanisms connecting early life stress exposure to obesity risk in young children longitudinally should be a priority for obesity researchers. Recommendations for developmentally sensitive approaches to research that can inform obesity prevention strategies are presented.

Association Between Maternal Stress, Work Status, Concern About Child Weight, and Restrictive Feeding Practices in Preschool Children

Objectives To examine the relationship between maternal stress, work status, concern about child weight, and the use of restrictive feeding practices among mothers of preschool children. Methods 285 mothers of 2-to-5-year-old children completed an on-line survey. Questions included demographics, items from the Depression Anxiety Stress Scale, and the Child Feeding Questionnaire. Linear regression and ANOVA examined the relationship between maternal stress, work hours, concern about child weight, and the use of restrictive practices for one 2-to-5-year-old child living within the home. Results Mothers were 32.6 ± 5.2 years of age and spent 39.7 ± 12.0 h/week at work. Seventy-one percent worked full time. Children were 3.4 ± 1.0 years of age and 51% male. Stress (3.41 ± 0.77, p ≤ 0.001) and concern about child weight (3.41 ± 0.77, p ≤ 0.00) were associated with the use of restrictive feeding practices. Mothers with severe/extremely severe stress used restriction more than mothers with normal stress, respectively (3.63 ± 0.80, 3.30 ± 0.81, p = 0.03). No difference was found among mothers with mild/moderate stress (3.50 ± 0.63, p = 0.06). There was no association between work hours (p = 0.50) or work status (p = 0.91) and the use of restrictive feeding practices. Conclusions Maternal stress and concern about child weight were associated with the use of restrictive feeding practices. Considering the current rates of childhood obesity in the United States, understanding factors that influence a child's food environment is advantageous and can help improve maternal and child health.

Associations Between Maternal Depressive Symptoms and Nonresponsive Feeding Styles and Practices in Mothers of Young Children: A Systematic Review

BACKGROUND

Childhood obesity is a significant global public health problem due to increasing rates worldwide. Growing evidence suggests that nonresponsive parental feeding styles and practices are important influences on children's eating behaviors and weight status, especially during early childhood. Therefore, understanding parental factors that may influence nonresponsive parental feeding styles and practices is significant for the development of interventions to prevent childhood obesity.

OBJECTIVE

The objectives of this systematic review were to (1) identify and review existing research examining the associations between maternal depressive symptoms and use of nonresponsive feeding styles and practices among mothers of young children (2-8 years of age), (2) highlight the limitations of reviewed studies, and (3) generate suggestions for future research.

METHODS

Using the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) guidelines, six electronic academic databases were searched for peer-reviewed, full-text papers published in English between January 2000 and June 2016. Only studies with mothers 18+ years old of normally developing children between 2 and 8 years of age were included. Of the 297 citations identified, 35 full-text papers were retrieved and 8 were reviewed.

RESULTS

The reviewed studies provided mixed evidence for associations between maternal depressive symptoms and nonresponsive feeding styles and practices. Two out of three studies reported positive associations with nonresponsive feeding styles, in that mothers with elevated depressive symptoms were more likely than mothers without those symptoms to exhibit uninvolved and permissive or indulgent feeding styles. Furthermore, results of reviewed studies provide good evidence for association between maternal depressive symptoms and instrumental feeding (3 of 3 reviewed studies) and nonresponsive family mealtime practices (3/3), but mixed evidence for pressuring children to eat (3/6) and emotional feeding (1/3). In addition, evidence for the association between maternal depressive symptoms and restricting child food intake was mixed: one study (1/6) found a positive association; two studies (2/6) found a negative association; whereas one study (1/6) found no association.

CONCLUSIONS

This review indicates that the results of studies examining the associations between maternal depressive symptoms and parental feeding styles and practices are mixed. Limitations of studies included in this review should be noted: (1) the use of a diverse set of self-report questionnaires to assess parental feeding practices is problematic due to potential misclassification and makes it difficult to compare these outcomes across studies, thus caution must be taken in drawing conclusions; and (2) the majority of included studies (6/8) were cross-sectional. There is a need for additional longitudinal studies to disentangle the influence of depression on parental feeding styles and practices. Nevertheless, given that depressive symptoms and feeding styles and practices are potentially modifiable, it is important to understand their relationship to inform obesity prevention interventions and programs.

Association between maternal lifestyle and preschool nutrition

Introduction:

Many of the health behaviors involved in the emergence of chronic non-communicable diseases (CNCD) are originated in childhood under parental influence. Mothers are the ones most involved in the education and health care of children. Lifestyle (LS) is a social determinant of health. Very few studies tried to understand the influence of maternal LS on child nutrition.

Objective:

To verify the association between maternal behavioral and non-behavioral LS and nutritional aspects in preschool children.

Method:

From January 2010 to December 2010, we performed a cross-sectional study with 255 mothers of preschool children who were residents of five different sub-districts in southwestern São Paulo. A proportional stratified random sample was selected using two layers ("schools" and "children"). From the mother, sociodemographic and LS information were collected. From the child, data on anthropometry, sedentary behavior and food intake were collected. The association was calculated using chi-square test and logistic regression.

Results:

Children who ate minimally processed food were born from mothers with more socially aware non-behavioral LS, while children that ate more processed food were born from mothers with more consumerist non-behavioral LS. No association was found between nutritional characteristics of preschoolers and types of maternal behavioral LS. Children presenting "sedentary behavior" and the habit of eating "ultra-processed foods" had 113% and 84% higher chances, respectively, of being born to mothers that belonged to the "consumerist" cluster.

Conclusion:

Mothers living a consumerist lifestyle can promote negative influences on child nutrition.

Controlling feeding practices and maternal migrant background: an analysis of a multicultural sample

Objective

Parental feeding practices shape children’s relationships with food and eating. Feeding is embedded socioculturally in values and attitudes related to food and parenting. However, few studies have examined associations between parental feeding practices and migrant background.

Design

Cross-sectional study. Parental feeding practices (restriction, pressure to eat, monitoring) were assessed using the Child Feeding Questionnaire. Differences were explored in four sub-samples grouped by maternal place of birth: Sweden, Nordic/Western Europe, Eastern/Southern Europe and countries outside Europe. Crude, partly and fully adjusted linear regression models were created. Potential confounding variables included child’s age, gender and weight status, and mother’s age, weight status, education and concern about child weight.

Setting

Malmö and Stockholm, Sweden.

Subjects

Mothers (n1325, representing seventy-three countries; mean age 36·5 years; 28·1 % of non-Swedish background; 30·7 % with overweight/obesity; 62·8 % with university education) of pre-school children (mean age 4·8 years; 50·8 % boys; 18·6 % with overweight/obesity).

Results

Non-Swedish-born mothers, whether European-born or non-European-born, were more likely to use restriction. Swedish-born mothers and Nordic/Western European-born mothers reported lower levels of pressure to eat compared with mothers born in Eastern/Southern Europe and mothers born outside Europe. Differences in monitoring were small. Among the potential confounding variables, child weight status and concern about child weight were highly influential. Concern about child weight accounted for some of the effect of maternal origin on restriction.

Conclusions

Non-European-born mothers were more concerned about children being overweight and more likely to report controlling feeding practices. Future research should examine acculturative and structural factors underlying differences in feeding.

The More and Less Study: a randomized controlled trial testing different approaches to treat obesity in preschoolers

Background

While obesity has been shown to be difficult to treat in school aged children and in adolescence, promising results have been detected for children who started treatment in early childhood. Yet knowledge on the effectiveness of structured early childhood obesity treatment programs is limited, preventing the widespread implementation of such programs. The main objective of this study is to evaluate the effectiveness of early treatment of childhood obesity with respect to treatment focus (parenting practices or lifestyle), length and intensity. The study will also examine the influence of gender, age, parental weight status, parenting practices, child behavior as well as parents’ socioeconomic status and child and parental psychosocial health on children’s weight status.

Methods/design

This is a parallel open label randomized controlled trial assessing two different behavioral treatment approaches offered in three conditions to families with children aged 4–6 years in Stockholm County, Sweden. Children (n = 180) identified as obese will be referred from primary child health care, school health care, and from outpatient pediatric clinics, and randomized to: 1) a standard treatment with focus on lifestyle, provided within the current healthcare system (n = 90); 2) a 10-session, 1.5 h/week group treatment with focus on parenting (n = 45); or 3) the same group treatment as 2) with additional follow-up sessions (n = 45). The primary study outcome is change in children’s body mass index standard deviation score (BMI SDS) one year post-baseline. Secondary outcomes include changes in children’s waist circumference, metabolic health, lifestyle patterns (Food Frequency Questionnaire), obesity-related child behaviors (Child Eating Behavior Questionnaire and Lifestyle Behavior Checklist, Problem Scale), parents’ general and feeding parenting practices (Communicating with Children and Child Feeding Questionnaire) and lifestyle-specific self-efficacy (Lifestyle Behavior Checklist, Confidence Scale), family functioning (Family Assessment Device), child and parental psychosocial health (Child Behavior Checklist and Beck’s Depression Inventory II).

Discussion

This study will facilitate a close examination of key components of treatment for obesity during early childhood and mechanisms of change. Results from this study will lead to better healthcare options for obesity treatment during early childhood and ultimately to the prevention of obesity later in life.

Trial registration

ClinicalTrials.gov NCT01792531 Registered February 14, 2013.

Do stressed mothers have heavier children? A meta-analysis on the relationship between maternal stress and child body mass index

Child obesity continues to be a prevalent public health issue. This meta-analysis synthesized 17 studies investigating the association between levels of psychological stress experienced by mothers and the body mass index of their children. The overall standardized mean difference effect size was positive and significantly different from zero in cross-sectional d = 0.20 (k = 14, 95% confidence interval [CI]: 0.06, 0.34) and longitudinal studies d = 0.18 (k = 5, 95% CI: 0.00, 0.351) and had significant heterogeneity in both (cross-sectional, Q[13] = 193.00, P < 0.001; longitudinal, Q[4] = 29.46, P < 0.001). In longitudinal studies, effect sizes were larger when children also would have experienced the stressor, Q(6) = 4.68, P < 0.05, for toddlers than infants, Q(4) = 5.04, P < 0.05, and in higher quality studies, Q(4) = 14.58, P < 0.05. Results highlight the potential benefits of including a parent stress management component in childhood obesity prevention programmes.

Associations between maternal depressive symptoms and child feeding practices in a cross-sectional study of low-income mothers and their young children

Background

Maternal depression may influence feeding practices important in determining child eating behaviors and weight. However, the association between maternal depressive symptoms and feeding practices has been inconsistent, and most prior studies used self-report questionnaires alone to characterize feeding. The purpose of this study was to identify feeding practices associated with maternal depressive symptoms using multiple methodologies, and to test the hypothesis that maternal depressive symptoms are associated with less responsive feeding practices.

Methods

In this cross-sectional, observational study, participants (n = 295) included low-income mothers and their 4- to 8-year-old children. Maternal feeding practices were assessed via interviewer-administered questionnaires, semi-structured narrative interviews, and videotaped observations in home and laboratory settings. Maternal depressive symptoms were measured using the Center for Epidemiologic Studies-Depression scale (CES-D). Regression analyses examined associations between elevated depressive symptoms (CES-D score ≥16) and measures of maternal feeding practices, adjusting for: child sex, food fussiness, number of older siblings; and maternal age, body mass index (BMI), education, race/ethnicity, single parent status, perceived child weight, and concern about child weight.

Results

Thirty-one percent of mothers reported depressive symptoms above the screening cutoff. Mothers with elevated depressive symptoms reported more pressuring of children to eat (β = 0.29; 95% Confidence Interval (CI): 0.03, 0.54) and more overall demandingness (β = 0.16; 95% CI: 0.03, 0.29), and expressed lower authority in child feeding during semi-structured narrative interview (Odds Ratio (OR) for low authority: 2.82; 95% CI: 1.55, 5.12). In homes of mothers with elevated depressive symptoms, the television was more likely audible during meals (OR: 1.91; 95% CI: 1.05, 3.48) and mothers were less likely to eat with children (OR: 0.48; 95% CI: 0.27, 0.85). There were no associations between maternal depressive symptoms and encouragement or discouragement of food in laboratory eating interactions.

Conclusions

Mothers with elevated depressive symptoms demonstrated less responsive feeding practices than mothers with lower levels of depressive symptoms. These results suggest that screening for maternal depressive symptoms may be useful when counseling on healthy child feeding practices. Given inconsistencies across methodologies, future research should include multiple methods of characterizing feeding practices and direct comparisons of different methodologies.

An examination of comorbid asthma and obesity: assessing differences in physical activity, sleep duration, health-related quality of life and parental distress

OBJECTIVE

Compare youth with comorbid asthma and obesity to youth with obesity only to determine if differences exist in body mass index, dietary intake, levels of physical activity, sleep duration and health-related quality of life. Levels of parent distress were also compared.

METHODS

Participants included 248 children (n = 175 in Obesity group; n = 73 in Asthma + Obesity group) with a BMI ≥ 85th percentile for age and gender, and their participating parent(s) or legal guardian(s). Measures of child height and weight were obtained by study personnel and Z-scores for child body mass index were calculated using age- and gender-specific norms. Child physical activity and sleep duration were measured via accelerometers. Dietary intake, health-related quality of life and parent distress were assessed via self-report.

RESULTS

The Asthma + Obesity group evidenced significantly higher body mass index scores, and had lower sleep duration. There was a non-statistically significant trend for lower levels of physical activity among children in the Asthma + Obesity group. Dietary intake, health-related quality of life and parent distress did not differ between groups.

CONCLUSIONS

Youth with comorbid asthma and obesity are at increased risk for negative health and psychosocial difficulties compared to youth who are overweight or obese only. Professionals providing treatment for youth with asthma are encouraged to assess the implications of weight status on health behaviors and family psychosocial adjustment.